Introduction Existing literature regarding the efficacy and safety of anti-tumour necrosis factor (TNF) therapy in the elderly with inflammatory bowel disease (IBD) is scare and conflicting. The aim of this study is to assess the consequences of anti-TNF therapy (infliximab and adalimumab) in elderly patients with IBD.
Methods A retrospective single-centre analysis of all patients ≥50 years-old who were commenced on an anti-TNF agent for IBD between September 2013 - August 2015 was performed. Patients who received less than 2 doses were excluded. The type of anti-TNF used was recorded, and whether immunomodulators were commenced prior to anti-TNF therapy. Data on treatment efficacy, treatment failure and adverse events was collected.
Results 19/44 patients were male and 25/44 were female. The majority of patients (81.8%, 36/44) had a diagnosis of Crohn’s Disease, compared with 18.2% (8/44) with Ulcerative Colitis (UC). Results were analysed within subgroups based on age. The majority of patients (24/44, 55%) were aged 50–59, with 15/44 (34%) aged 60–69 and 4/44 (9%) aged 70–79. Treatment efficacy was measured by readmission with an IBD-flare and a requirement for surgery after being treated with anti-TNF. The rate of readmission with a flare was low across all age groups; of those aged 50–59, 8.3% (2/24) were readmitted, compared with 20% (3/15) aged 60–69 and 25% (1/4) aged 70–79. The median days for readmission following anti-TNF was >100 days. The number of patients who required surgery also represented a small proportion: 1 patient in age 50–59 band required anal stricture dilatation, and 2 patients in age 60–69 band required a subtotal colectomy and end ileostomy for UC. Adverse events were assessed by significant reactions to treatment, infections requiring hospitalisation, a malignancy presenting after treatment, and mortality. The incidence of these adverse events was low, and did not follow any pattern related to the age of the patient at treatment (Figure 1 and 2), and none of the deaths observed were directly related to IBD. 40% (6/15) of patients aged 60–69 required admission to hospital due to infection; however no patients in the age bands of 50–59 or 70+ had this outcome. The infective aetiology was diverse. The median days of presentation after starting anti-TNF was >200 days.
Conclusion Treatment efficacy, failure and the incidence of adverse events among older patients on anti-TNF therapy appears to be low and unrelated to increasing age. Our research suggests that anti-TNF therapy is an effective and safe treatment option for IBD patients aged over 50 who have failed previous immunomodulator therapy.
Reference 1 Lobaton et al. Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2015 Aug;42(4):441–51. doi:10.1111/apt.13294. Epub 2015 Jun 24.
Disclosure of Interest None Declared
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