Comparative safety and effectiveness of tumor necrosis factor α antagonists and vedolizumab in elderly IBD patients: a multicentre study

Tomer Adar, David Faleck, Saranya Sasidharan, Kelly Cushing, Nienke Z. Borren, Niharika Nalagatla, Ryan Ungaro, Wayne Sy, Samuel C. Owen, Anish Patel, Benjamin L. Cohen, Ashwin N. Ananthakrishnan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

79 Scopus citations

Abstract

Background: The older patient group with inflammatory bowel diseases (IBD) is particularly vulnerable to consequences of disease and therapy-related side effects but little is known about the best treatment options in this population. Aim: To compare safety and efficacy of tumor necrosis factor α antagonist (anti-TNF) or vedolizumab (VDZ) in patients with IBD >60 years of age. Methods: This retrospective study included patients with Crohn's disease (CD) or ulcerative colitis (UC) initiating anti-TNF or VDZ therapy ≥60 years of age at three study sites. We examined occurrence of infection or malignancy within 1 year after therapy as our primary outcome. Our efficacy outcomes included clinical remission at 3, 6 and 12 months. Multivariable logistic regression models adjusting for relevant confounders estimated odds ratios (OR) and 95% confidence intervals. Results: The study included 131 anti-TNF and 103 VDZ initiated patients (age range 60-88 years). Approximately half had CD. At 1 year, there were no significant differences in safety profile between the two therapeutic classes. Infections were observed in 20% of anti-TNF-treated and 17% of VDZ-treated patients (P = 0.54). Pneumonia was the most common infection in both groups. While more anti-TNF-treated CD patients were in remission at 3 months compared to VDZ (OR 2.82, 95% CI 1.18-6.76), this difference was not maintained at 6 and 12 months suggesting similar efficacy of both classes. Conclusions: Both anti-TNF and VDZ therapy were similarly effective and safe in elderly IBD patients.

Original languageEnglish
Pages (from-to)873-879
Number of pages7
JournalAlimentary Pharmacology and Therapeutics
Volume49
Issue number7
DOIs
StatePublished - Apr 2019
Externally publishedYes

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