Sa1134 Advanced Age Is Not Associated With Lower Safety and Efficacy of Anti-Tumor Necrosis Factor Therapy in the Treatment of Inflammatory Bowel Disease

Vliet, Quirine M. van der; Aalst, Karen S. van der; Thije, Jacobus J. ten; Have, Mike van der; Sijtsma, Leonie; Aalst, Anniek M. van der; Ponsioen, Cyriel Y.; Tuyl, Sebastiaan A. van; Jong, Andrea E. van der Meulen de; Oldenburg, Bas; Fidder, Herma H.

doi:10.1016/s0016-5085(15)30774-5

Cited by 3 publications

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“…[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. 9,41,42 Most studies were retrospective cohorts; only 2 were prospective studies.…”

Section: Literature Searchmentioning

confidence: 99%

“…Twelve studies compared the safety of biologics in older compared with younger patients while 8 studies compared the safety of biologics in older patients compared with an older nonbiologic control population. Of these 14 studies, 6 were among patients with IBD (n ¼ 349 older biologic patients), 7,8,32,33,41,42 1 study included those with psoriasis (n ¼ 135 older biologic patients), 40 and 7 examined those with RA (n ¼ 4235 older biologic patients). 9,[34][35][36][37][38][39] The mean age of included participants was 71 years of age for older biologic users (data from 11 studies), 43 years of age for younger biologic users (data from 10 studies), and 72 years of age in the older nonbiologic control patients (data from 6 studies).…”

Section: Study Characteristicsmentioning

confidence: 99%

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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%

Section: Study Characteristicsmentioning

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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Efficacy and safety of biological treatment for inflammatory bowel disease in elderly patients: Results from a GETECCU cohort

Suárez Ferrer,

Mesonero Gismero,

Caballol

et al. 2024

Gastroenterología y Hepatología

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Systematic review with meta‐analysis: biologics and risk of infection or cancer in elderly patients with inflammatory bowel disease

Piovani

Danese

Peyrin–Biroulet

et al. 2020

Aliment Pharmacol Ther

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Background: Uncertainty exists concerning the risk of infection and cancer associated with biologic therapies in elderly patients with inflammatory bowel disease (IBD). Aims:To identify, synthesise and critically appraise the available evidence on the topic. Methods:We systematically searched Medline/PubMed, Embase and Scopus, through October 2019, and recent conference proceedings, to identify studies investigating the risk of serious infections, opportunistic infections, any infection and cancer in elderly IBD patients (>60 years) exposed to biologics as compared to those unexposed to biologics. Two reviewers independently extracted study data and assessed each study's risk of bias. We examined heterogeneity, and calculated summary effect estimates using fixed-and random effects models. Quality of evidence was determined with GRADE. Results:We included 15 studies (one post hoc analysis of a randomised trial, nine cohort and five case-control studies). Elderly IBD patients treated with biologics were at increased risk of developing serious infections (random effects summary relative risk: 2.70, 95% CI: 1.56-4.66; seven studies; I 2 = 57%) and opportunistic infections (3.16, 1.09-9.20; four studies; I 2 = 73%). The occurrence of any infection (1.67, 0.51-5.43; five studies; I 2 = 75%) and cancer (0.90, 0.64-1.26; nine studies; I 2 = 0%) was not significantly affected. Nevertheless, our confidence in the effect estimates is rather limited; the quality of evidence is low to very low. Conclusions:Biologics are likely to increase the risk of serious and opportunistic infections in old IBD patients. Large prospective studies are needed to further assess the biologic treatments' long-term safety profile in this population. | 821PIOVANI et Al.

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Sa1134 Advanced Age Is Not Associated With Lower Safety and Efficacy of Anti-Tumor Necrosis Factor Therapy in the Treatment of Inflammatory Bowel Disease

Cited by 3 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

Efficacy and safety of biological treatment for inflammatory bowel disease in elderly patients: Results from a GETECCU cohort

Systematic review with meta‐analysis: biologics and risk of infection or cancer in elderly patients with inflammatory bowel disease

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