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Hahn GD, Golovics PA, Wetwittayakhlang P, Santa Maria DM, Britto U, Wild GE, Afif W, Bitton A, Bessissow T, Lakatos PL. Safety of Biological Therapies in Elderly Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11154422. [PMID: 35956040 PMCID: PMC9369299 DOI: 10.3390/jcm11154422] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 02/06/2023] Open
Abstract
Background and Aim: Newer biologics appeared safer in landmark clinical trials, but their safety is understudied in vulnerable populations. The aim of the present study was to perform a systematic review and meta-analysis to assess the safety of available biologicals in the elderly IBD population. Methods: We systematically searched PubMed/Medline and conference proceedings between 1 April 1969 and 1 June 2021 to identify eligible studies that examined the safety of biologics in elderly patients with IBD. Of the 2885 articles and 12 congress abstracts identified, 12 peer reviewed papers and 3 abstracts were included after independent evaluation by two reviewers. The identified studies collected safety data on anti-TNF, vedolizumab (VDZ) and ustekinumab (UST). Results: Rates of AE and infections were not different among the biologics (AE mean rate: 11.3 (CI 95% 9.9–12.7)/100 pts-years; p = 0.11, infection mean rate: 9.5 (CI 95% 8.4–10.6)/100 pts-years; p = 0.56) in elderly IBD patients on anti-TNF, VDZ or UST. Infusion/injection reaction rates were more common on anti-TNFs (mean rate: 2.51 (CI 95% 1.7–3.4/100 pts-years; p = 0.02). and malignancy rates were higher on VDZ/UST (mean rate: 2.14 (CI 95% 1.6–2.8)/100 pts-years; p = 0.01). Conclusions: Rates of AEs and infections were not different among biologicals. Infusion/injection reactions were more common on anti-TNFs. Current data are insufficient to suggest the sequencing of biologicals in elderly patients based on safety.
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Affiliation(s)
- Gustavo Drügg Hahn
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
- School of Medicine, Graduate Course Sciences in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil; (D.M.S.M.); (U.B.)
| | - Petra Anna Golovics
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
- Department of Gastroenterology, Hungarian Defense Forces, Medical Centre, 1062 Budapest, Hungary
| | - Panu Wetwittayakhlang
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
- Unit of Gastroenterology and Hepatology, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Dirlene Melo Santa Maria
- School of Medicine, Graduate Course Sciences in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil; (D.M.S.M.); (U.B.)
| | - Usiara Britto
- School of Medicine, Graduate Course Sciences in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil; (D.M.S.M.); (U.B.)
| | - Gary Edward Wild
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
| | - Peter Laszlo Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
- 1st Department of Medicine, Semmelweis University, 1085 Budapest, Hungary
- Correspondence:
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