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

Summary

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.

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