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P626 Higher discontinuation rates of anti-TNF therapy in elderly IBD patients compared with a younger age group: results from a prospective registry

L. Smits*1, M. de Jong1, N. den Broeder1, M. Russel2, T. Römkens3, R. West4, J. Jansen5, F. Hoentjen1

1Radboud University Medical Center, Gastroenterology and Hepatology, Nijmegen, The Netherlands, 2Medisch Spectrum Twente, Gastroenterology and Hepatology, Enschede, The Netherlands, 3Jeroen Bosch Ziekenhuis, Gastroenterology and Hepatology, 's Hertogenbosch, The Netherlands, 4Franciscus Gasthuis and Vlietland, Gastroenterology and Hepatology, Rotterdam, The Netherlands, 5Onze Lieve Vrouwe Gasthuis, Gastroenterology and Hepatology, Amsterdam, The Netherlands

Background

Increasing life expectancy and IBD incidence will result in more elderly IBD patients. There is paucity of data on safety and efficacy of anti-TNF in the elderly since this group is underrepresented in clinical studies. We aimed to compare the long-term effectiveness and safety of first anti-TNF treatment in IBD patients per age group (20–40 years/41–60 years/>60 years), by assessment of drug survival and reasons for discontinuation.

Methods

Patients on first anti-TNF treatment were identified through IBDREAM, a multi-centre prospective IBD registry in 5 hospitals in the Netherlands. Data on demographics, medical history, drug survival and adverse events were extracted from IBDREAM. STATA 11.2’s competing risk regression was used to study time to drug discontinuation due to adverse events or lack of effectiveness, with discontinuation due to remission as a competing risk. The following predictors were considered in the analysis, corrected for age group: gender, IBD-type, anti-TNF type (infliximab or adalimumab), co-medication at baseline, disease duration, malignancies and surgery in medical history.

Results

A total of 895 patients were included, 679 had Crohn’s disease, 200 ulcerative colitis and 16 IBD unclassified. Male represented 42%, median age at diagnosis was 26 years (IQR 19–38) and median follow-up was 46 months (IQR 18–97). 546 patients started anti-TNF at an age between 20 and 40 (61%), 268 at age 41–60 (30%) and 81 at age >60 (9%). Infliximab was the first anti-TNF in 75%, 71%, and 67% of patients, respectively, per age group. A total of 450 patients discontinued first anti-TNF therapy, 284 (52%), 133 (50%) and 33 (41%) per group. Reasons for discontinuation were adverse events in 27%, 29% and 39%, respectively per age group, lack of effectiveness in 40%, 47% and 32% and remission in 15%, 30% and 3%. Competing-risks regression analysis, with discontinuation due to adverse events/ lack of effectiveness as the outcome of interest and discontinuation due to remission as a competing event, showed a shorter drug survival in the two older groups (subhazard rate (SHR) age >60 1.46, SHR age 41–60 1.21; p = 0.03, both SHR compared with age <40) (Figure 1). Risk factor for discontinuation was prednisone use at baseline (SHR: 2.78; p < 0.001).

Conclusion

IBD patients starting the first anti-TNF agent at higher age showed a higher discontinuation rate due to adverse events or lack of effectiveness, with patients >60 years having the highest rate of discontinuation. Prednisone use at baseline was the only other predictor found for discontinuation.

Figure 1. Cumulative incidence function of discontinuation in patients who started anti-TNF at age 20–40/41–60/>60 as estimated by the competing risk regression model.