1
|
Holvoet T, Truyens M, De Galan C, Peeters H, Gismero FM, Elorza A, Torres P, Vandermeulen L, Jauregui-Amezaga A, Ferreiro-Iglesias R, Zabana Y, Reverter LP, Geldof J, Lobatón T. Safety and Effectiveness of Vedolizumab and Ustekinumab in Elderly Patients with Inflammatory Bowel Disease: A Real-Life Multicentric Cohort Study. J Clin Med 2024; 13:365. [PMID: 38256499 PMCID: PMC10816258 DOI: 10.3390/jcm13020365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Data on ustekinumab and vedolizumab in the elderly inflammatory bowel disease (IBD) population are limited. The aim of the current study was to assess the safety and effectiveness of both in an elderly real-life population. METHODS A multicentric retrospective study was performed on IBD patients who started vedolizumab or ustekinumab between 2010 and 2020. Clinical and endoscopic remission rates and (serious) adverse events (AE) were assessed. RESULTS A total of 911 IBD patients were included, with 171 (19%) aged above 60 (111 VDZ, 60 UST). Elderly patients treated with vedolizumab or ustekinumab had an increased risk for non-IBD hospitalization (10.5% vs. 5.7%, p = 0.021) and malignancy (2.3% vs. 0.5%, p = 0.045) compared to the younger population. Corticosteroid-free clinical (50% vs. 44%; p = 0.201) and endoscopic remission rates (47.9% vs. 31%, p = 0.07) at 1 year were similar. Comparing vedolizumab to ustekinumab in the elderly population, corticosteroid-free (47.9% vs. 31%, p = 0.061) and endoscopic remission rates (66.7% vs. 64.4%, p = 0.981) were similar. Vedolizumab- and ustekinumab-treated patients had comparable infection rates (13.5% vs. 10.0%, p = 0.504), IBD flare-ups (4.5% vs. 5%, p = 1.000), the occurrence of new EIMs (13.5% vs. 10%, p = 0.504), a risk of intestinal surgery (5.4% vs. 6.7%, p = 0.742), malignancy (1.8% vs. 3.3%, p = 0.613), hospitalization (9.9% vs. 11.7%, p = 0.721), and mortality (0.9% vs. 1.7%, p = 1.000). AE risk was associated only with corticosteroid use. CONCLUSIONS Ustekinumab and vedolizumab show comparable effectiveness and safety in the elderly IBD population. Elderly IBD patients have an increased risk for non-IBD hospitalizations and malignancy compared to the younger IBD population, with corticosteroid use as the main risk factor.
Collapse
Affiliation(s)
- Tom Holvoet
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium; (M.T.); (C.D.G.); (J.G.); (T.L.)
- Ghent Gut Inflammation Group (GGIG), Ghent University, 9000 Ghent, Belgium
- Department of Gastroenterology, VITAZ, 9100 Sint-Niklaas, Belgium
- Department of Gastroenterology, UZ Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Marie Truyens
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium; (M.T.); (C.D.G.); (J.G.); (T.L.)
- Ghent Gut Inflammation Group (GGIG), Ghent University, 9000 Ghent, Belgium
- VIB Center for Inflammation Research (IRC), Ghent University, 9000 Ghent, Belgium
- Department of Gastroenterology, University Hospital Ghent, 9000 Ghent, Belgium
| | - Cara De Galan
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium; (M.T.); (C.D.G.); (J.G.); (T.L.)
- Ghent Gut Inflammation Group (GGIG), Ghent University, 9000 Ghent, Belgium
- VIB Center for Inflammation Research (IRC), Ghent University, 9000 Ghent, Belgium
| | - Harald Peeters
- Department of Gastroenterology, AZ Sint Lucas, 9000 Ghent, Belgium;
| | - Francisco Mesonero Gismero
- Department of Gastroenterology, Hospital Ramon y Cajal, 28034 Madrid, Spain;
- Department of Internal Medicine, Universidad de Alcalá de Henares, 28805 Madrid, Spain
| | - Ainara Elorza
- Department of Gastroenterology, Hospital de Galdakao, 48960 Bilbao, Spain;
| | - Paola Torres
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, 08916 Barcelona, Spain;
| | - Liv Vandermeulen
- Department of Gastroenterology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium
| | - Aranzazu Jauregui-Amezaga
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, 2650 Antwerp, Belgium;
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Division of Gastroenterology and Hepatology, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium
| | - Rocio Ferreiro-Iglesias
- Department of Gastroenterology, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain;
| | - Yamile Zabana
- Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Laia Peries Reverter
- Department of Gastroenterology, Hospital Universitari de Girona, 17007 Girona, Spain;
| | - Jeroen Geldof
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium; (M.T.); (C.D.G.); (J.G.); (T.L.)
- Department of Gastroenterology, University Hospital Ghent, 9000 Ghent, Belgium
| | - Triana Lobatón
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium; (M.T.); (C.D.G.); (J.G.); (T.L.)
- Department of Gastroenterology, UZ Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Department of Gastroenterology, University Hospital Ghent, 9000 Ghent, Belgium
| |
Collapse
|
3
|
Ananthakrishnan AN, Donaldson T, Lasch K, Yajnik V. Management of Inflammatory Bowel Disease in the Elderly Patient: Challenges and Opportunities. Inflamm Bowel Dis 2017; 23:882-893. [PMID: 28375885 PMCID: PMC5687915 DOI: 10.1097/mib.0000000000001099] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The population of older patients with inflammatory bowel disease (IBD) continues to grow, partly reflecting the aging global population in general. The debilitating effects of IBD compound age-related decrements in health and functional capacity, and make the medical management of older patients with Crohn's disease and ulcerative colitis distinctly challenging to clinicians. Here, we review the recent literature describing the pharmacologic management of IBD in this population, with focus on the safety, tolerability, and efficacy of common treatment options, such as steroids, immunomodulators, tumor necrosis factor-α antagonists, and integrin antagonists; surgical interventions in older patients are also discussed. Few studies have systematically and prospectively evaluated the clinical challenges in the medical management of IBD in this patient population, leaving a limited evidence base to which clinicians can turn to for guidance. Treatment patterns may thus be suboptimal. For example, prolonged steroid use in the elderly was found to be common, causing significant morbidity from side effects in a particularly vulnerable population. Finally, within the context of a limited evidence base, we discuss common treatment scenarios to define the parameters within which physicians can individualize care for older patients with IBD. Overall, older patients with IBD are at higher risk of adverse events and less treatment responsiveness compared with younger patients, underscoring the need for future studies to fully characterize appropriate treatment courses for this population.
Collapse
Affiliation(s)
| | | | - Karen Lasch
- Takeda Pharmaceuticals USA, Inc., Deerfield, IL, USA
| | - Vijay Yajnik
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Nimmons D, Limdi JK. Elderly patients and inflammatory bowel disease. World J Gastrointest Pharmacol Ther 2016; 7:51-65. [PMID: 26855812 PMCID: PMC4734955 DOI: 10.4292/wjgpt.v7.i1.51] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/13/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) is increasing globally. Coupled with an ageing population, the number of older patients with IBD is set to increase. The clinical features and therapeutic options in young and elderly patients are comparable but there are some significant differences. The wide differential diagnosis of IBD in elderly patients may result in a delay in diagnosis. The relative dearth of data specific to elderly IBD patients often resulting from their exclusion from pivotal clinical trials and the lack of consensus guidelines have made clinical decisions somewhat challenging. In addition, age specific concerns such as co-morbidity; loco-motor and cognitive function, poly-pharmacy and its consequences need to be taken into account. In applying modern treatment paradigms to the elderly, the clinician must consider the potential for more pronounced adverse effects in this vulnerable group and set appropriate boundaries maximising benefit and minimising harm. Meanwhile, clinicians need to make personalised decisions but as evidence based as possible in the holistic, considered and optimal management of IBD in elderly patients. In this review we will cover the clinical features and therapeutic options of IBD in the elderly; as well as addressing common questions and challenges posed by its management.
Collapse
|
5
|
Shung DL, Abraham B, Sellin J, Hou JK. Medical and surgical complications of inflammatory bowel disease in the elderly: a systematic review. Dig Dis Sci 2015; 60:1132-40. [PMID: 25501923 DOI: 10.1007/s10620-014-3462-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/21/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIMS The complications of therapy, hospitalization, and surgery related to inflammatory bowel disease (IBD) in the elderly are not well described. While multiple reviews have described the management and complications of elderly patients with IBD, none have been performed in a systematic fashion. METHODS We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate the association between elderly patients with IBD and complications from therapy, hospitalizations, and surgery. Eligible studies were identified via structured keyword searches in PubMed and manual literature searches. RESULTS A total of 5,644 publications were identified. Of these, fourteen studies met inclusion criteria, encompassing 963 elderly IBD patients (113 Crohn's disease and 850 ulcerative colitis patients), over 37,000 hospitalizations of elderly IBD patients and over 4,500 controls. Consistent associations were observed between increased age and higher nocturnal stool frequency post-ileal pouch anal anastomosis. Only two studies met inclusion criteria for medication-related complications, one observed an increased mortality and infection risk among elderly patients treated with tumor necrosis factor antagonists and the other observed increased hospital-related complications among elderly patients treated with steroids. CONCLUSIONS Elderly patients with IBD are at an increased risk of hospital- and therapy-related complications. We found a paucity of high-quality studies evaluating outcomes in elderly patients with IBD. Further studies of elderly patients with IBD are needed to further evaluate the effect of age on medical and surgical complications.
Collapse
Affiliation(s)
- Dennis L Shung
- Baylor College of Medicine, One Baylor Plaza BCM:901, Houston, TX, 77030, USA
| | | | | | | |
Collapse
|
6
|
Gisbert JP, Chaparro M. Systematic review with meta-analysis: inflammatory bowel disease in the elderly. Aliment Pharmacol Ther 2014; 39:459-77. [PMID: 24405149 DOI: 10.1111/apt.12616] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/03/2013] [Accepted: 12/20/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Elderly patients represent an increasing proportion of the inflammatory bowel disease (IBD) population. AIM To critically review available data regarding the care of elderly IBD patients. METHODS Bibliographic searches (MEDLINE) up to June 2013. RESULTS Approximately 10-15% of cases of IBD are diagnosed in patients aged >60 years, and 10-30% of the IBD population are aged >60 years. In the elderly, IBD is easily confused with other more common diseases, mainly diverticular disease and ischaemic colitis. The clinical features of IBD in older patients are generally similar to those in younger patients. Crohn's disease (CD) in elderly patients is characterised by its predominantly colonic localisation and uncomplicated course. Proctitis and left-sided ulcerative colitis are more common in patients aged >60 years. Infections are associated with age and account for significant mortality in IBD patients. The treatment of IBD in the elderly is generally similar. However, the therapeutic approach in the elderly should be 'start low-go slow'. The benefit of thiopurines in older CD patients remains debatable. Although the indications for anti-tumour necrosis factors in the elderly are generally similar to those for younger patients, lower response and higher adverse events have been reported in the elderly. Surgery in elderly patients does not generally differ. Ileal pouch-anal anastomosis can be successful, provided the patient retains good anal sphincter function. CONCLUSIONS Management of the older IBD patient differs from that of younger patients; therefore, conventional practice algorithms may have to be modified to account for advanced age.
Collapse
Affiliation(s)
- J P Gisbert
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | | |
Collapse
|
7
|
Exercise Training Reduces Inflammatory Mediators in the Intestinal Tract of Healthy Older Adult Mice. Can J Aging 2012; 31:161-71. [DOI: 10.1017/s0714980812000104] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
RÉSUMÉLe vieillissement s’allie à une augmentation d’inflammation intestinale et le risque élevé de maladies chroniques, y compris les maladies inflammatoires de l’intestin et le cancer du côlon; nombreuses études épidémiologiques indiquent que l’exercice régulier réduit les risques. Cette étude a examiné les effets à long terme de l’exercice volontaire sur les médiateurs inflammatoires dans les intestins des souris âgées et en bonne santé C57BL/6 (âgées de 15–16 mois). On a désigné les animaux soit à quatre mois de roue d’exercice à souris (RES ; n – 20), soit à une groupe de contrôle « sédentaire » (NRL ; n = 20). Les lymphocytes intestinaux ont été récoltés et analysés pour la présence de (1) pro-inflammatoire (TNF-a, IL-1β) et de cytokines pléotropes (IL-6), et (2) de pro-(caspase-3/-7) et d’anti-(Bcl-2) protéines apoptotiques. L’efficacité d’exercise a été confirmée par l’activité des enzymes dans les muscles squelettiques ; l’évidence de stress a été confirmée par un plasma 8-iso-PGF2α et la corticostérone. Les RES souris ont réalisés une incidence inférieure de TNF-α, de la caspase-7, et de 8-isoprostanes (p < .05) par rapport aux contrôles sédentaires, ce qui suggère que l’exercice à long terme peut « protéger » l’intestin en réduisant la manifestation de cytokines inflammatoires et du protéine apoptotique.
Collapse
|