Mo1179 Efficacy and Safety of Anti-TNF Therapy in Elderly Patients With Inflammatory Bowel Disease

Ortega, Triana Lobatón; Vermeire, Séverine; Ballet, Vera; Rutgeerts, Paul; Assche, Gert A. Van; Ferrante, Marc

doi:10.1016/s0016-5085(14)62095-3

Cited by 4 publications

(1 citation statement)

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“…18 Thirteen studies were excluded because they did not have sufficient data for the control population. [19][20][21][22][23][24][25][26][27][28][29][30][31] Thus, our final analysis included 14 unique studies. [7][8][9][32][33][34][35][36][37][38][39][40][41][42] Of these, 3 studies had only the abstract available for review, but sufficient detailed information could be extracted to allow for inclusion.…”

Section: Literature Searchmentioning

confidence: 99%

Safety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

Borren

Ananthakrishnan

2019

Clinical Gastroenterology and Hepatology

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e108. Learning Objective-Upon completion of this activity, successful learners will be able to define the diagnosis, natural history, and treatment of IBD in older individuals. BACKGROUND & AIMS: Management of immune-mediated inflammatory diseases often requires lifelong immunosuppression. Increasing numbers of older patients have inflammatory diseases and are particularly vulnerable to risks of immune suppressive therapies-particularly infections and malignancies. METHODS: We systematically searched PubMed/Medline and Embase to identify eligible studies that examined the safety of biologic therapies in older patients with immune-mediated inflammatory diseases (inflammatory bowel disease, rheumatoid arthritis, psoriasis). Included studies provided information on patients who began receiving therapy with a biologic agent when they were older than 60 years and a control population (either younger users of biologics or older patients who did not use biologics). Information of on overall pooled rates of infections, malignancy, and mortality were extracted. A DerSimonian and Laird random effects model was used to calculate pooled odds ratios (ORs) and 95% CIs. RESULTS: Our meta-analysis included 14 unique studies that comprised 4719 older users of biologics, 13,305 younger users of biologics, and 3961 older patients who did not use biologics. The pooled prevalence of infections in older and younger users of biologics was 13% and 6% respectively, yielding a pooled random effects odds ratio of 2.28 (95% CI, 1.57-3.31). Older age was associated with a significant increase in risk of malignancy (OR, 3.07; 95% CI, 1.98-4.62) compared to younger age. Older users of biologics had a 3-fold increase in risk of infection compared to patients who did not use biologics (OR, 3.60; 95% CI, 1.62-8.01), but there were no significant differences in odds of malignancy (0.54, 95% CI, 0.28-1.05) or death (OR, 1.52; 95% CI, 0.44-5.28) compared to older patients who did not use biologics. CONCLUSION: In a systematic review and meta-analysis of studies on the safety of biologic therapies in older patients with inflammatory diseases, we found that older users of biologic agents have an increased risk of infections compared with younger users or older patients who do not use biologics. Large, prospective cohort studies are needed to examine safety of biologic therapy in older patients with immune-mediated diseases

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Section: Literature Searchmentioning

confidence: 99%

Safety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

Borren

Ananthakrishnan

2019

Clinical Gastroenterology and Hepatology

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Risks of Infection among the Older Inflammatory Bowel Disease Patients

2014

Curr Treat Options Gastro

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Accumulating evidence has demonstrated improved clinical outcomes with earlier initiation of immunosuppressive therapy for patients with inflammatory bowel disease (IBD). However, current evidence-based treatment paradigms are not often applied to the older IBD patients, as they represent a higher-risk group for disease and medication-associated complications, particularly infection. Serious infections, associated with increased hospitalizations, morbidity, and mortality, are more common among the older IBD patients. Although immunosuppression and advanced age are risk factors for infection, additional variables such as increasing disease activity, comorbidity, and declining functional status also play a role. Finding the optimal balance between therapeutic efficacy and safety for older IBD patients with moderate to severe disease activity poses a great challenge to the practicing clinician particularly as the therapeutic armamentarium expands to include more immunologic targets in the future to be used in combination with currently available therapies. Patient selection, looking beyond numeric age, with prompt and appropriate medication prescribing relative to disease activity and corticosteroid dependence is key to maximizing efficacy and decreasing infection-related risks. Additionally, practitioners should be proactive with respect to older IBD patients with an emphasis on preventative care, including vaccinations and nutritional and functional status assessments, to address potentially modifiable risk factors for serious infection.

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Drug Management in the Elderly IBD Patient

Kim

Katz

Green

2015

Curr Treat Options Gastro

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Managing inflammatory bowel disease (IBD) in a world of immunomodulators and biologics is complex enough, but managing the elderly IBD patient is further confounded by multiple comorbidities, polypharmacy with drug-drug interactions, and cognitive mobility/motility disturbances. Social and insurance coverage issues also always lurk in the background. All of these factors summate into a daunting challenge for the clinician. In this review, we aim to describe important considerations when prescribing to an elderly patient with IBD, taking into account costs of medications, drug interactions, the aging body's effect on pharmacokinetics, and the effect of aging on the immune system. Adverse effects and drug-drug interactions are expounded upon in detail specific for the aging adult with IBD in an effort to assist the clinician in the decision-making process.

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Mo1179 Efficacy and Safety of Anti-TNF Therapy in Elderly Patients With Inflammatory Bowel Disease

Cited by 4 publications

References 0 publications

Safety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

Safety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

Risks of Infection among the Older Inflammatory Bowel Disease Patients

Drug Management in the Elderly IBD Patient

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