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. 2022 Sep 7;28(33):4823-4833.
doi: 10.3748/wjg.v28.i33.4823.

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

Gustavo Drügg Hahn  1   2 , Jean-Frédéric LeBlanc  3 , Petra Anna Golovics  1   4 , Panu Wetwittayakhlang  1   5 , Abdulrahman Qatomah  1 , Anna Wang  1 , Levon Boodaghians  1 , Jeremy Liu Chen Kiow  6 , Maryam Al Ali  1 , Gary Wild  1 , Waqqas Afif  1 , Alain Bitton  1 , Peter Laszlo Lakatos  7 , Talat Bessissow  1
Affiliations

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

Gustavo Drügg Hahn et al. World J Gastroenterol. .

Abstract

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 scant.

Aim: To evaluate retrospectively the drug sustainability, effectiveness, and safety of the biologic therapies in the elderly IBD population.

Methods: 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 2020. Efficacy 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 therapy.

Results: 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 infection.

Conclusion: 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.

Keywords: Adverse events; Biologics; Efficacy; Elderly; Inflammatory bowel disease; Safety.

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Conflict of interest statement

Conflict-of-interest statement: Hahn GD, Qatomah A, Wang A, Boodaghians L, Liu Chen Kiow J, Al Ali M, and Wild G declared no conflict of interest; LeBlanc JF has been a speaker or advisory board member for Janssen and Takeda; Golovics PA has been a speaker for AbbVie, Takeda, Fresenius, Ferring; Wetwittayakhlang P has been a speaker and/or advisory board member: Takeda, Pfizer, Janssen, Ferring, A. Menerini, and MSD; Afif W has been a speaker for Janssen, Prometheus, Dynacare, Takeda, AbbVie Theradiag; Bitton A has been a member of Advisory Boards - Abbvie, Pfizer, Takeda, Janssen, Merck; Speaker’s bureau - Abbvie, Janssen, Takeda, Pfizer; Lakatos PL has been a speaker and/or advisory board member for AbbVie, Arena, Falk Pharma GmbH, Ferring, Genetech, Janssen, Kyowa Hakko Kirin Pharma, Mitsubishi Tanabe Pharma Corporation, MSD, Pfizer, Roche, Shire, Takeda and Tillots, and has received unrestricted research grants from AbbVie, MSD and Pfizer; Bessissow T has been a speaker or advisory board member for Takeda, Janssen, Abbvie, Merck, Pfizer, Pendopharm, Ferring, Shire, Sandoz, BMS, Roche, Fresenius Kabi, Viatris.

Figures

Figure 1
Figure 1
Time based on biologic therapy. A: Treatment discontinuation; B: Adverse event; C: Infection.
Figure 2
Figure 2
Clinical response and remission rates in elderly inflammatory bowel disease patients treated with different biologicals according to Harvey-Bradshaw Index or Mayo scores. A: At 3 mo; B: At 6-9 mo; C: After 12-18 mo. CD: Crohn’s disease; UC: Ulcerative colitis; IBD: Inflammatory bowel disease.
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