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Multicenter Study
. 2022 Nov 1;34(11):1132-1139.
doi: 10.1097/MEG.0000000000002436. Epub 2022 Sep 10.

Safety and effectiveness of ustekinumab in elderly Crohn's disease patients

Joseph Fiske  1 , Eleanor Liu  2 , Jimmy K Limdi  2   3 , Thomas E Conley  1 , Tristan Townsend  1 , Mike Davies  4 , Robert Brockwell  4 , Daniyal Baig  1 , Sherif Abdelbadiee  1 , Anastasia Uney  1 , Angela Liaros  5 , Waqas Gaba  6 , Philip J Smith  1 , Paul K Flanagan  1 , Sreedhar Subramanian  1   7
Affiliations
Multicenter Study

Safety and effectiveness of ustekinumab in elderly Crohn's disease patients

Joseph Fiske et al. Eur J Gastroenterol Hepatol. .

Abstract

Objective: Anti-tumour necrosis factor (TNF) agents are associated with increased infection risk among elderly IBD patients, but little is known about non anti-TNF biologics in this cohort. We examined the safety and effectiveness of ustekinumab in elderly Crohn's patients.

Methods: This retrospective multi-centre cohort study included Crohn's patients ≥60-years old who commenced ustekinumab. We recorded Harvey-Bradshaw index (HBI), concomitant steroid therapy, treatment persistence and new infections or malignancies. Primary outcome was serious infections requiring hospitalisation.

Results: Seventy patients were included, with median age of 68 years. 43 (61.4%) had prior anti-TNF exposure, and 15 (21.4%) vedolizumab. Median treatment duration was 12 months, totalling 84 patient-years. Nine serious infections were reported, incidence 106.7/1000 patient-years. Systemic steroids were associated with increased risk of serious infections [odds ratio (OR) 7.83, 95% confidence interval (CI): 1.44-44.32, P = 0.02]. There were 27 "non-serious" infections; 321.4/1000 patient-years. Charlson co-morbidity index (OR 1.49, 95% CI: 1.05-2.12, P = 0.03) and steroid exposure (OR 44.10, 95% CI: 1.75-1112.10, P = 0.02) increased non-serious infection risk (P < 0.05). Mean HBI improved from 8.13 to 4.64 at 6 months and 4.10 at last follow up (P < 0.0001). 12-month treatment persistence was 55.7% (N = 39); 34 (48.6%) were steroid-free.

Conclusion: Ustekinumab was safe and effective in a cohort of elderly Crohn's disease patients. Infections were mostly mild, not resulting in therapy discontinuation. Serious infection risk was comparable to previously reported rates with anti-TNF agents. Steroid exposure was associated with an increased serious infection risk.

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