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Effectiveness, safety, and drug sustainability of biologics in elderly patients with inflammatory bowel disease: A retrospective study

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World Journal of Gastroenterology 2022年第33期28卷 4823-4833页

作者： gustavo drugg hahn Jean-Frederic LeBlanc Petra Anna Golovics Panu Wetwittayakhlang Abdulrahman Qatomah Anna Wang Levon Boodaghians Jeremy Liu Chen Kiow Maryam Al Ali Gary Wild Waqqas Afif Alain Bitton Peter Laszlo Lakatos Talat Bessissow Division of Gastroenterology IBD CenterMcGill University Health CenterMontreal H3G 1A4QuebecCanada School of Medicine Graduate Course Sciences in Gastroenterology and HepatologyUniversidade Federal do Rio Grande do SulPorto Alegre 90000-000Brazil Division of Gastroenterology McGill University Health CentreMontreal H3G 1A4QuebecCanada Department of Gastroenterology Hungarian Defense ForcesMedical CentreBudapest 1134Hungary Unit of Gastroenterology and Hepatology Division of Internal MedicineFaculty of MedicinePrince of Songkla UniversitySongkhla 90110Thailand Department of Gastroenterology Centre Hospitalier de l’Universitede MontrealMontreal H2X 3E4QuebecCanada

BACKGROUND Biologic therapy resulted in a significant positive impact on the management of inflammatory bowel disease(IBD) however data on the efficacy and side effects of these therapies in the elderly is *** To evaluate retrospectively the drug sustainability, effectiveness, and safety of the biologic therapies in the elderly IBD *** Consecutive elderly(≥ 60 years old) IBD patients, treated with biologics [infliximab(IFX), adalimumab(ADAL), vedolizumab(VDZ), ustekinumab(UST)] followed at the McGill University Inflammatory Bowel Diseases Center were included between January 2000 and *** was measured by clinical scores at 3, 6-9 and 12-18 mo after initiation of the biologic therapy. Patients completing induction therapy were included. Adverse events(AEs) or serious AE were collected during and within three months of stopping of the biologic *** We identified a total of 147 elderly patients with IBD treated with biologicals during the study period, including 109 with Crohn’s disease and 38 with ulcerative colitis. Patients received the following biologicals: IFX(28.5%), ADAL(38.7%), VDZ(15.6%), UST(17%). The mean duration of biologic treatment was 157.5(SD = 148) wk. Parallel steroid therapy was given in 34% at baseline,19% at 3 mo, 16.3% at 6-9 mo and 6.5% at 12-18 mo. The remission rates at 3, 6-9 and 12-18 mo were not significantly different among biological therapies. Kaplan-Meyer analysis did not show statistical difference for drug sustainability(P = 0.195), time to adverse event(P = 0.158) or infection rates(P = 0.973) between the four biologics studied. The most common AEs that led to drug discontinuation were loss of response, infusion/injection reaction and *** Current biologics were not different regarding drug sustainability, effectiveness, and safety in the elderly IBD population. Therefore, we are not able to suggest a preferred sequencing order among biologicals.

关键词： Inflammatory bowel disease Biologics Elderly Efficacy Safety Adverse events

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