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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Sex‐based differences in the incidence of inflammatory bowel diseases—pooled analysis of population‐based studies from the Asia‐Pacific region

Summary

Background

There appear to be differences in risk factor profiles for IBD between Asia‐Pacific and Western populations, which might suggest idiosyncrasies in pathogenesis. Recently, sex‐based differences in IBD according to the age of diagnosis have been described in Western populations.

Aim

Our primary aim was to identify whether sex‐based differences in IBD incidence similarly exist across the age spectrum for Asia‐Pacific populations.

Methods

We identified Asia‐Pacific population‐based cohorts where IBD incidence data stratified by sex were available for the full age spectrum. Cohorts were included only if IBD diagnoses were confirmed and validated. We calculated incidence rate ratios of Crohn's disease (CD) and ulcerative colitis (UC) according to age and compared differences between males and females using random‐effects meta‐analysis.

Results

Among 567.8 million people from 11 Asia‐Pacific countries/provinces/nations, we identified 10 553 incident CD cases (7060 males; 3493 females) and 16 946 incident UC cases (9754 males; 7192 females). Starting in early adolescence until age 50 years, there was a 36%‐64% higher incidence of CD in males vs females (P < 0.001). UC incidence ranged from 20%‐42% higher in males vs females in the age groups between 15 and 65 years (P < 0.05).

Conclusions

In a pooled analysis of population‐based studies from the Asia‐Pacific region, we found a male predominance of both CD and UC for the majority of the age spectrum from adolescence to middle/late‐middle age. Additional studies are needed to clarify biological and nonbiological determinants of sex differences in IBD, which might be distinct between Asia‐Pacific and Western populations.

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More research needed to help survivors with fear of recurrence

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Issue Information

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First Person: Howard Koh, MD, MPH

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Persisting Regional Disparities in Modern Contraceptive Use and Unmet Need for Contraception among Nigerian Women

Background. Evidence suggests that equitable provision of contraceptive services can help women achieve their reproductive goals and has significant impact on reducing the rates abortion and unintended pregnancy at large. However, regional disparities continue to persist on top of low family planning prevalence which is a critical public health challenge for fast growing populations like Nigeria. Objectives. The present study aimed to explore the prevalence of (1) nonuse of modern contraceptives, (2) unmet need for contraception, and (3) regional disparities in these two. Methods. The present study used cross-sectional data obtained from the Nigeria Demographic and Health Surveys conducted in 2003, 2008, and 2013. Participants were women of reproductive of age (15-49 years) regardless of marital status. Regional disparities of nonuse of modern contraceptives and unmet need were analysed by descriptive and multivariate regression methods. Results. In the pooled sample of 79,656 participants during 2003, 2008, and 2013, 88.6% reported not using any modern methods, and 13.5% reported having unmet need for contraception. The prevalence rates of nonuse were, respectively, 91.8%, 90.6%, and 88.6% and those of unmet need were 14.2%, 16.6%, and 13.5% in the years 2003, 2008, and 2013. Significant differences were observed in the odds of reporting nonuse and unmet need for contraception across the geopolitical zones. Conclusions. The rates of nonuse of contraception are remarkably high among women in Nigeria with significant disparities across the six geopolitical zones. Efforts should be made to address the regional disparities in order to achieve the goals of universal coverage of family planning services in the country.

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Retinoblastoma mutation predicts poor outcomes in advanced non small cell lung cancer

Our study shows that retinoblastoma (RB1) mutation is associated with decreased overall survival in patients with locally advanced and advanced non small cell lung cancer. We also show that RB1 mutation correlates with lack of response to immunotherapy.

Abstract

The retinoblastoma gene (RB1) encodes the retinoblastoma (RB) pocket protein that plays an important role in cell cycle progression. Here we determine the frequency and prognostic significance of RB1 mutation in non small cell lung cancer (NSCLC), restricting inclusion to Stage III and IV patients with linked genomic and clinical data. The primary outcome was median overall survival (OS). We identified RB1 mutation in 8.2% of NSCLC patients. The median OS for wild‐type (wt) RB1 was 28.3 months vs 8.3 months for mutant RB1 (Hazard Ratio = 2.59, P = 0.002). Of special interest, RB1 mutation also correlated with lack of response to immunotherapy. Our study focused on RB1 mutation in locally advanced and advanced non small cell lung cancer to better facilitate comparisons with small cell lung cancer (SCLC). In our SCLC cohort, RB1 mutation was identified in 75% of patients and wt RB1 was associated with significantly shorter OS (P = 0.002). The different outcomes of RB1 mutation observed among lung cancer subtypes suggest a more complicated mechanism than simple regulation of cell cycle or response to chemotherapy.

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