TNF inhibitors less effective for older-onset IBD patients
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Anti-tumor necrosis factor therapy had reduced efficacy and safety for bio-naive patients with older-onset inflammatory bowel disease compared with younger patients, according to a study published in Scientific Reports.
“Anti-TNF treatment is effective for both the induction and maintenance of patients with IBD and improves their quality of life. The efficacy and safety of anti-TNF treatment for [elderly onset IBD (EO-IBD)] are not yet clear, however, because elderly patients are generally not included in large-scale studies such as randomized controlled trials,” Takahiro Amano, of the department of gastroenterology and hepatology at Osaka University Graduate School of Medicine in Japan, and colleagues wrote.
The researchers added: “Although a few observational cohorts have suggested that anti-TNF treatment for elderly patients with IBD, including those with [nonelderly onset IBD (NEO-IBD)], have a higher rate of treatment discontinuation and severe adverse events such as infection, there has been no comparative analysis investigating the outcomes of anti-TNF treatment by distinguishing between elderly patients with EO-IBD and NEO-IBD.”
Amano and colleagues enrolled 432 bio-naive IBD patients, aged 16 years and older, from 18 hospitals in Japan in a retrospective, multicenter study. Participants had been diagnosed and hospitalized with IBD, including ulcerative colitis and Crohn’s disease, and had undergone anti-TNF treatment between January 2010 to March 2019. Elderly patients were defined as those aged 60 years and older and were further divided into those with EO-IBD (at least 60 years old at the time of diagnosis) and those with NEO-IBD.
Elderly onset was found to be a significant factor for both clinical remission (OR = 0.49; 95% CI, 0.25-0.96) and steroid-free remission (OR = 0.51; 95% CI, 0.26-0.99) after 52 weeks of anti-TNF treatment, with clinical and steroid-free remission rates significantly lower in EO-IBD patients vs. non-elderly patients (37.7% and 60.8%; P=0.001, and 35.9% and 57.8%; P=0.003, respectively). Clinical and steroid-free remissions rates did not differ significantly between NEO-IBD patients and non-elderly patients.
In addition, the rates of cumulative discontinuation and severe adverse events were significantly higher in patients with EO-IBD compared with non-elderly and NEO-IBD patients.
“In conclusion, anti-TNF treatment for bio-naive EO-IBD may be less effective and raise safety concerns,” the researchers noted.
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