Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease.

Background The general increased life expectancy is reflected in the age of patients with inflammatory bowel disease ( IBD). The knowledge about efficacy and safety of anti-tumour necrosis factor ( TNF) therapy in elderly is scarce and conflicting. Aim To assess the efficacy and safety of anti- TNF therapy in elderly patients taking into account eventual comorbidity. Methods Observational and retrospective single-centred study where 66 IBD patients initiating anti- TNF treatment at age ≥65 years (cases: ≥65 anti- TNF) were compared with 112 IBD patients initiating anti- TNF <65 years (controls <65 anti- TNF) and 61 anti- TNF naïve IBD patients treated with immunosuppressants ( IMS) and/or corticosteroids ( CS) ≥65 years (controls ≥65 IMS/ CS). Controls were matched to cases for IBD type, follow-up, disease duration and anti- TNF type. Comorbidity was assessed by using the Charlson Comorbidity Index ( CCI). Both efficacy and safety of treatment were adjusted for comorbidity. Results The short-term clinical response to anti- TNF at 10 weeks was significantly lower in cases: ≥65 anti- TNF (68% vs. 89%; P < 0.001), whereas at ≥6 months, differences were not significant (79.5% vs. 82.8%; P = 0.639). The risk for any severe adverse events was higher in cases: ≥65 anti- TNF than in controls <65 anti- TNF ( RR = 4.7; P < 0.001) or controls ≥65 IMS/ CS ( RR = 3.09; P = 0.0008). Age older than 65 and CCI > 0 were independent risk factors for malignancy and mortality regardless of the medication. Conclusion Elderly patients treated with anti- TNF have a lower rate of short-term clinical response and a higher rate of severe adverse events than the younger patients under the same treatment. [ABSTRACT FROM AUTHOR]