Vedolizumab, ustekinumab best anti-TNF for infection risk in older adult IBD
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SAN DIEGO — Vedolizumab and ustekinumab associated with a lower risk for infection-related hospitalizations compared with anti-tumor necrosis factor agents in patients who initiated inflammatory bowel disease therapy at an older age.
“It used to be thought that IBD becomes a milder disease with age and, therefore, there never was a tremendous investment in better understanding modern biologic agents in older adults,” Bharati Kochar, MD, MS, a gastroenterologist at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School, told attendees at Digestive Disease Week 2022. “However, we increasingly know that the number of older adults requiring immunosuppression for the treatment of IBD is rapidly rising, and it’s also well established that older adults have a higher baseline risk for infections compared with younger adults.”
Using a U.S. nationwide commercial insurance plan database, Kochar and colleagues identified 3,693 patients with IBD (mean age, 67-68 years) who initiated treatment with anti-TNF (2,369), vedolizumab (972) or ustekinumab (352). They quantified comorbidity using the Charlson comorbidity index (CCI) and included infection-related hospitalizations and infection occurrence as study outcomes.
According to analysis, the risk for infection-related hospitalizations was similar among patients on vedolizumab (HR = 0.94; 95% CI, 0.84-1.04) or ustekinumab (HR = 0.92; 95% CI, 0.74-1.16) compared with patients on anti-TNF therapy. In addition, patients on vedolizumab or ustekinumab with a CCI score greater than 1 also had a lower risk for infection-related hospitalizations (HR = 0.78; 95% CI, 0.65-0.94 and HR = 0.66; 95% CI, 0.46-0.91, respectively) compared with those on anti-TNF therapy; this difference was not noted among patients without any serious comorbidities.
Overall, older age and comorbidity independently correlated with a higher risk for infection-related hospitalizations.
“For older adults with greater morbidity, vedolizumab and ustekinumab confer a lower risk for infection-related hospitalizations compared with anti-TNF agents,” Kochar concluded. “We found no overall difference in the rate of serious infections for older adults treated with anti-TNF agents, vedolizumab and ustekinumab. We believe this data informs the positioning of biologic agents among adults 60 years and older with inflammatory bowel diseases.”
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Kochar B, et al. Abstract 455. Presented at: Digestive Disease Week. May 21-24, 2022; San Diego (hybrid meeting).
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