P318 Safety of Biological Therapies in Elderly IBD: a Systematic Review and Meta-analysis
Drügg Hahn, G.(1);Golovics, P.(1);Wetwittayakhlang, P.(1);Santa Maria, D.(2);Britto, U.(2);Wild, G.(1);Afif, W.(1);Bessissow, T.(1);Bitton, A.(1);LakatosPhD, P.L.(1);
(1)Mcgill University Health Center, IBD Centre, Montréal, Canada;(2)Universidade Federal do Rio Grande do Sul, Departamento de Estatística, Porto Alegre, Brazil;
There was a significant progress in the medical therapy of inflammatory bowel diseases(IBD) with the advent of biological compounds, yet patients may experience adverse events(AE): infusion/injection reactions, infections and malignancies, understudied in vulnerable patient populations (e.g. elderly).
We systematically searched PubMed/Medline and conferences proceedings between January 1, 2010, and June 1, 2021, to identify eligible studies that examined the safety of biologic therapies in elderly patients with IBD. Two reviewers independently evaluated the collected studies based on inclusion and exclusion criteria. Search was focused on MESH Terms including IBD/CD/UC, biological therapy, adverse events, infections, infusion/injection reaction and malignancy and elderly.
Our search identified 2885 articles and 12 congress abstracts trough the data base search, finally 14 peer reviewed papers and 3 abstracts met the inclusion criteria. Most studies were retrospective, merging CD and UC patients, with an age limit of 60 or 65 years for elderly, from Europe or North America. According to our meta-analysis the rates of AE were not different according to the type of biologics (mean rate: 11.3 (CI 95% 9.9-12.7)/100 pts years; p=0.11) in elderly IBD patients with the use of anti-TNF, vedolizumab(VDZ) and ustekinumab(UST). Similarly, rates of infection (mean rate: 9.5 (CI 95% 8.4-10.6)/100 pts years; p=0.56). On the other hand, regarding infusion/injection rates were more common in patients on anti-TNFs (mean rate: 2.51 (CI 95% 1.7-3.4/100 pts years; p=0.02) and malignancy rates were higher in elderly patients on VDZ/UST (mean rate: 2.14 (CI 95% 1.6-2.8)/100 pts years; p=0.01). Two studies directly comparing anti-TNF and VDZ reported similar efficacy and safety in the elderly IBD population.
(p=0.56; Total: reflects patient year of follow-up.)
We report the first meta-analysis on the comparative safety of biological therapies in elderly IBD patients. Rates of adverse events and infections were not different across the biologics. In contrast, infusion/injection reactions were more common in patients on anti-TNFs. Current data are insufficient to suggest sequencing among biologicals in the elderly based on the safety, larger studies in elderly IBD population are warranted.