Adar T¹, Faleck D², Sasidharan S³, Cushing K¹, Borren NZ¹, Nalagatla N¹, Ungaro R², Sy W², Owen SC⁴, Patel A³, Cohen BL², Ananthakrishnan AN¹. Aliment Pharmacol Ther. 2019 Feb 17. doi: 10.1111/apt.15177. [Epub ahead of print]

Author information

1 Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.

2 Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York.

3 Division of Hospital Medicine, Massachusetts General Hospital, Boston, Massachusetts.

4 Division of Gastroenterology, Brooke Army Medical Center, Fort Sam Houston, Texas.

Abstract

BACKGROUND: The older patient group with inflammatory bowel diseases (IBD) is particularly vulnerable to consequences of disease and therapy-related side effects but little is known about the best treatment options in this population.

AIM: To compare safety and efficacy of tumor necrosis factor α antagonist (anti-TNF) or vedolizumab (VDZ) in patients with IBD >60 years of age.

METHODS: This retrospective study included patients with Crohn's disease (CD) or ulcerative colitis (UC) initiating anti-TNF or VDZ therapy ≥60 years of age at three study sites. We examined occurrence of infection or malignancy within 1 year after therapy as our primary outcome. Our efficacy outcomes included clinical remission at 3, 6 and 12 months. Multivariable logistic regression models adjusting for relevant confounders estimated odds ratios (OR) and 95% confidence intervals.

RESULTS: The study included 131 anti-TNF and 103 VDZ initiated patients (age range 60-88 years). Approximately half had CD. At 1 year, there were no significant differences in safety profile between the two therapeutic classes. Infections were observed in 20% of anti-TNF-treated and 17% of VDZ-treated patients (P = 0.54). Pneumonia was the most common infection in both groups. While more anti-TNF-treated CD patients were in remission at 3 months compared to VDZ (OR 2.82, 95% CI 1.18-6.76), this difference was not maintained at 6 and 12 months suggesting similar efficacy of both classes.

CONCLUSIONS: Both anti-TNF and VDZ therapy were similarly effective and safe in elderly IBD patients.