P371 Are biologics a safe option for elderly patients with inflammatory bowel disease?
L. Sparks*, S. Mann
Barnet & Chase Farm Hospitals, Royal Free London NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom
A significant proportion of patients with inflammatory bowel disease (IBD) are elderly. In general, the management of elderly patients is similar to that of young patients, although there is a paucity of data on the use of biologics in this age group. The main concerns relate to toxicities such as infections which may be higher in this age group (Cottone M, et al. Clin Gastro Hepatol 2011;9:30-5, Lichtenstein G, et al. Clin Gastro Hepatol 2006;4:621-30).We therefore aimed to review our IBD database to examine the outcomes for patients over the age of 60 years who have received anti-TNF agents.
Barnet and Chase Farm Hospitals are sister district hospitals in Hertfordshire serving a population of 500,000. Data were extracted from the hospital electronic patient record for all patients with Crohn’s disease (CD) or ulcerative colitis (UC) who had received anti-TNF drugs (Infliximab [IFX] or Adalimumab [ADA]) over the age of 60. Demographic data, disease distribution, previous treatments, and outcomes were obtained.
Our database had 155 patients in all age groups currently on or previously on anti-TNF drugs. Twenty patients (13% of total) were identified for this study (mean age, 70 years; range 22-84; CD=16; UC= 4). Median age at IBD diagnosis was 60 yrs (CD; range 22-84) and 57 yrs (UC; range 52 -60). Median age starting biologics was 64 yrs (CD; range 59-85) and 62 yrs (UC; range 58-77). CD patients received IFX (n=9) and ADA (n=7), compared with UC patients (IFX=3, ADA=1). Drugs previously trialled included 5-ASA drugs (CD-75%; UC-50%), thiopurines (CD-56%; UC-100%), corticosteroids (CD-100%; UC-100%), tacrolimus (n=1) and some patients had switched biologics (CD-43% of ADA users; UC-1 ADA user). Patients were on biologics for a median 1.75 yrs (CD) and 1.88 yrs (UC). Steroid-free clinical remission was achieved in 50% of patients (CD and UC). Primary non-response was seen in 2 patients (CD-1, UC-1). Minor adverse events (all CD patients) included flu-like illness and weight gain (n=1), eczematous rash (n=1) and drug-induced lupus (n=1, drug discontinued).
We have administered anti-TNF agents to 20 patients over the age of 60 including 7 patients over the age of 70 yrs. The clinical remission rates were comparable with our younger cohort of patients with a 50% steroid-free remission rate. Only one patient had to discontinue the drug due to a lupus-like syndrome, and no patient experienced any infection related toxicities. All the patients satisfied published guidelines for starting biologics and although caution is necessary in terms of excluding high risk patients, we feel that age alone should not be a contra-indication to starting this class of drugs.