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Increased discontinuation rates of anti-TNF therapy in elderly inflammatory bowel disease patients.

BACKGROUND AND AIMS
There is paucity of data on safety and efficacy of anti-TNF in elderly inflammatory bowel disease (IBD) patients. We aimed to compare the long-term treatment failure rates and safety of a first anti-TNF agent in IBD patients between different age groups (<40 years/40-59 years/≥60 years).


METHODS
IBD patients who started a first anti-TNF agent were identified through IBDREAM, a multicentre prospective IBD registry. Competing risk regression was used to study treatment failure, defined as time to drug discontinuation due to adverse events (AEs) or lack of effectiveness, with discontinuation due to remission as a competing risk.


RESULTS
A total of 895 IBD patients were included, 546 started anti-TNF at age <40 (61.0%), 268 at age 40-59 (29.9%) and 81 at age >60 (9.1%). Treatment failure rate was higher in the two older groups (subhazard rate (SHR) age >60 1.46, SHR age 40-59 1.21;p=0.03). The SHR in elderly (>60) was 1.52 for discontinuation due to AEs and 1.11 for lack of effectiveness. Concomitant thiopurine use was associated with a lower treatment failure rate (SHR 0.78, 95%CI 0.62-0.98,p=0.031). SAE rate as well as serious infection rate was significantly higher in elderly IBD patients (61.2 versus 16.0 and 12.4 per 1000 py) while the malignancy rate was low in all age groups.


CONCLUSIONS
Elderly IBD patients starting a first anti-TNF agent showed a higher treatment failure rate, while concomitant thiopurine use at baseline was associated with lower failure rates. Elderly IBD patients demonstrated higher rates of SAEs and serious infections.