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P494. Elderly patients with inflammatory bowel disease under anti-TNF therapy: efficacy and safety

T. Lobaton Ortega1,2, S. Vermeire2, V. Ballet2, P. Rutgeerts2, G. Van Assche2, M. Ferrante2, 1Bellvitge University Hospital, Gastroenterology, Barcelona, Spain, 2University Hospital Leuven, Gastroenterology, Leuven, Belgium

Background

The general increased life expectancy is reflected in the age of patients with inflammatory bowel disease (IBD). The knowledge about efficacy and safety of anti-tumor necrosis factor (TNF) therapy in elderly is scarce and conflicting.

Our objectives were to assess the efficacy and safety of anti-TNF therapy in elderly patients taking into account eventual comorbidity.

Methods

Retrospective single-centre study where 63 IBD patients initiating anti-TNF treatment at age ≥65 years (cases) were compared to 118 IBD patients initiating anti-TNF at age <65 years (control 1) and 70 anti-TNF naïve IBD patients treated with azathioprine (AZA) and/or corticosteroids (CS) ≥65 years (control 2). Both control groups were matched to the case-group for type of IBD (Crohn's disease or ulcerative colitis), follow up, disease duration and type of anti-TNF (adalimumab or infliximab) in the case of control 1. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Both efficacy and safety of treatment were analyzed.

Results

Baseline characteristics are collected in Table 1. The short-term clinical response (STCR) to anti-TNF (4–10 weeks) was significantly lower in the elderly than in younger patients (67% vs. 87%; P < 0.001). At long-term (6 months) the differences were not significant. Considering all patients with a CCI = 0, age of ≥65 years remained a risk factor for lower STCR (62% vs. 87%; P < 0.001). In the univariate analysis cases had a higher rate of infection, surgery, Severe Adverse Event (SAE), malignancy and mortality (Table 1). In the multivariate analysis age remained as an independent risk factor for lower clinical response at short-term: OR 3.4 (95% CI 1.4–6.6, P = 0.005), severe infection (OR 4.2, 95% CI 1.2–14.4, P = 0.025) and SAE (OR 2, 95% CI 1.1–3.7, P = 0.029). Considering the 3 groups, age ≥65 and CCI > 0 were risk factors for malignancy and mortality.

Table 1. Baseline characteristics and adverse events
Cases:
≥65 anti-TNF
(n = 63)
Control 1:
<65 anti-TNF
(n = 118)
Control 2:
≥65 IS-CS
(n = 70)
Baseline characteristics
Female (%)606036 (p = 0.005)**
Median age (years) (IQR)69 (67–73)65 (65–68)35 (23–47) (p < 0.001)**
Comorbidity (% pat CCI >0)4620 (p < 0.001)*41
Median disease duration (years) (IQR)7 (2–22.3)5 (1–13)13 (3–22)
Median follow-up (months) (IQR)59 (19–93)74 (37–87)41 (19.5–85)
UC/CD (%)51/4948/5256/44
Adverse events
Infection with hospitalization (%)133 (p = 0.026)*16
Any severe adverse event (%)5639 (p = 0.028)*49
Need for surgery (%)191014
Death (%)6111
Malignancy (%)6214
*P value <0.05 comparing cases–control 1; **P value <0.05 comparing cases–control 2.

Conclusion

Elderly patients treated with anti-TNF have a lower rate of clinical response (regardless of their comorbidity). The rate of adverse events is higher in elderly patients but especially in those with a higher comorbidity.