Abstract
Background and Objective
Older people with inflammatory bowel disease (IBD) appear to have a lower response to anti-tumour necrosis factor (TNF) therapy, with more frequent complications than younger patients. The objective of this study was to assess persistence on therapy and the safety of anti-TNF therapy in older patients (aged ≥ 60 years).
Methods
We retrospectively reviewed the database of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD), extracting data regarding IBD patients aged ≥ 60 years and controls < 60 years of age at their first course of anti-TNF treatment. Data concerning persistence on therapy over the first year of treatment (primary objective) together with data on reasons for treatment withdrawal, concomitant diseases and treatments were collected.
Results
We identified 114 anti-TNF-naϊve patients aged ≥ 60 years (median age 64 years, range 60–80 years; 47 males) compared with 330 younger controls aged < 60 years (median age 39 years, range 18–59 years; 57 males). Older patients with Crohn’s disease (n = 73) showed a significantly lower persistence with every kind of anti-TNF therapy (whether analysed together [p < 0.001] or separately for intravenous and subcutaneous [SC] therapy) than younger controls, whereas older patients with ulcerative colitis (n = 41) showed a lower persistence when combining all kinds of anti-TNF treatment (p = 0.004) and for SC therapy. Secondary failures, infections, and neoplasias, but not primary failure, occurred more frequently in older IBD patients than in younger controls.
Conclusion
Despite a comparable number of primary failures, older IBD patients treated for the first time with anti-TNF agents showed lower treatment persistence due to higher rates of secondary failure, adverse events, infections, and tumours than younger patients in the first year of follow-up. The reasons for this difference still remain unclear.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.
Katz S, Pardi DS. Inflammatory bowel disease of the elderly: frequently asked questions (FAQs). Am J Gastroenterol. 2011;106:1889–97.
Baggenstos BR, Hanson BJ, Shaukat A. Treatment of ulcerative colitis in the elderly: a systematic review. Clin Med Insights Geriatrics. 2013;6:1–26.
Everhov ÅH, Halfvarson J, Myrelid P, Sachs MC, Nordenvall C, Söderling J, et al. Incidence and treatment of patients diagnosed with inflammatory bowel diseases at 60 years or older in Sweden. Gastroenterology. 2017;154:518–28.
Charpentier C, Salleron J, Savoye G, Fumery M, Merle V, Laberenne JE, et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut. 2014;63:423–32.
Jeuring SF, van den Heuvel TR, Zeegers MP, Hameeteman WH, Romberg-Camps MJ, Oostenbrug LE, et al. Epidemiology and long-term outcome of inflammatory bowel disease diagnosed at elderly age-an increasing distinct entity? Inflamm Bowel Dis. 2016;22:1425–34.
Fries W, Viola A, Manetti N, Frankovic I, Pugliese D, Monterubbianesi R, et al. Disease patterns in late-onset ulcerative colitis: results from the IG-IBD “AGED study”. Dig Liver Dis. 2017;49:17–23.
Beaugerie L, Brousse N, Bouvier AM, Colombel JF, Lémann M, Cosnes J, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet. 2009;374:1617–25.
Peyrin-Biroulet L, Khosrotehrani K, Carrat F, Bouvier AM, Chevaux JB, Simon T, et al. Increased risk for nonmelanoma skin cancers in patients who receive thiopurines for inflammatory bowel disease. Gastroenterology. 2011;141(1621–28):e1–5.
Bourrier A, Carrat F, Colombel JF, Bouvier AM, Abitbol V, Marteau P, et al.; CESAME study group. Excess risk of urinary tract cancers in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Aliment Pharmacol Ther. 2016;43:252-61.
Cottone M, Kohn A, Daperno M, Armuzzi A, Guidi L, D’Inca R, et al. Advanced age is an independent risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol. 2011;9:30–5.
Brassard P, Bitton A, Suissa A, Sinyavskaya L, Patenaude V, Suissa S. Oral corticosteroids and the risk of serious infections in patients with elderly-onset inflammatory bowel diseases. Am J Gastroenterol. 2014;109:1795–802.
Macaluso FS, Orlando R, Fries W, Scolaro M, Magnano A, Pluchino D, et al. The real-world effectiveness of vedolizumab on intestinal and articular outcomes in inflammatory bowel diseases. Dig Liver Dis. 2018;50:675–81.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
Parian A, Ha CY. Older age and steroid use are associated with increasing polypharmacy and potential medication interactions among patients with inflammatory bowel disease. Inflamm Bowel Dis. 2015;21:1392–400.
Desai A, Zator ZA, de Silva P, Nguyen DD, Korzenik J, Yajnik V, et al. Older age is associated with higher rate of discontinuation of anti-TNF therapy in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:309–15.
Lobatón T, Ferrante M, Rutgeerts P, Ballet V, Van Assche G, Vermeire S. Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2015;42:441–51.
Smits L, de Jong M, den Broeder N, Russel M, Römkens T, West R, et al. Higher discontinuation rates of anti-TNF therapy in elderly IBD patients compared with a younger age group: results from a prospective registry [abstract]. J Crohns Colitis 2019;13(Suppl_1):S430–1.
Khanna R, Bressler B, Levesque BG, Zou G, Stitt LW, Greenberg GR, et al.; REACT Study Investigators. Early combined immunosuppression for the management of Crohn’s disease (REACT): a cluster randomised controlled trial. Lancet. 2015;386:1825–34.
Paul S, Roblin X. Letter: immunogenicity of anti-TNF in elderly IBD patients [letter]. Aliment Pharmacol Ther. 2019;50:336.
Calafat M, Mañosa M, Panes J, Nos P, Iglesias E, Vera I, et al. Risk of immunomediated adverse events or secondary loss of response to infliximab in elderly patients with inflammatory bowel disease: a cohort study of the ENEIDA registry. J Crohns Colitis; 2019 13(Suppl_1):S328–29.
Adar T, Faleck D, Sasidharan S, Cushing K, Borren NZ, Nalagatla N, et al. Comparative safety and effectiveness of tumor necrosis factor α antagonists and vedolizumab in elderly IBD patients: a multicentre study. Aliment Pharmacol Ther. 2019;49:873–9.
Ebina K, Hashimoto M, Yamamoto W, Hirano T, Hara R, Katayama M, et al. Drug tolerability and reasons for discontinuation of seven biologics in elderly patients with rheumatoid arthritis -the ANSWER cohort study. PLoS One. 2019;14:e0216624.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Funding
The authors have no funding to declare for the present study.
Conflict of interest
With regard to the content of the paper, the authors SP, AV, AO, ACP, CF, MC, AV, SS, GI, AM, FM, RDM, NB, OF, SG, GM, CB, Ac, FSM, SR, MV, AA, MC and WF have no conflicts of interest to declare.
Ethical approval
The study was approved by the Ethics Committee of the coordinating centre (protocol number 191/18).
Rights and permissions
About this article
Cite this article
Porcari, S., Viola, A., Orlando, A. et al. Persistence on Anti-Tumour Necrosis Factor Therapy in Older Patients with Inflammatory Bowel Disease Compared with Younger Patients: Data from the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). Drugs Aging 37, 383–392 (2020). https://doi.org/10.1007/s40266-020-00744-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40266-020-00744-3