PMID- 31974546
OWN - NLM
STAT- MEDLINE
DCOM- 20210615
LR  - 20210615
IS  - 1876-4479 (Electronic)
IS  - 1873-9946 (Linking)
VI  - 14
IP  - 7
DP  - 2020 Jul 30
TI  - Increased Discontinuation Rates of Anti-TNF Therapy in Elderly Inflammatory Bowel 
      Disease Patients.
PG  - 888-895
LID - 10.1093/ecco-jcc/jjaa012 [doi]
AB  - BACKGROUND AND AIMS: There is paucity of data on safety and efficacy of 
      anti-tumour necrosis factor [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 the 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% confidence interval [CI] 0.62-0.98, 
      p = 0.031). Serious adverse event [SAE] rate, as well as serious infection rate, 
      were significantly higher in elderly IBD patients [61.2 versus 16.0 and 12.4 per 
      1000 patient-years, respectively] whereas the malignancy rate was low in all age 
      groups. CONCLUSIONS: Elderly IBD patients starting a first anti-TNF agent showed 
      higher treatment failure rates, but concomitant thiopurine use at baseline was 
      associated with lower failure rates. Elderly IBD patients demonstrated higher 
      rates of SAEs and serious infections.
CI  - (c) European Crohn's and Colitis Organisation (ECCO) 2020.
FAU - de Jong, M E
AU  - de Jong ME
AD  - Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, 
      Radboud University Medical Centre, Nijmegen, The Netherlands.
FAU - Smits, L J T
AU  - Smits LJT
AD  - Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, 
      Radboud University Medical Centre, Nijmegen, The Netherlands.
FAU - van Ruijven, B
AU  - van Ruijven B
AD  - Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, 
      Radboud University Medical Centre, Nijmegen, The Netherlands.
FAU - den Broeder, N
AU  - den Broeder N
AD  - Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, 
      Radboud University Medical Centre, Nijmegen, The Netherlands.
FAU - Russel, M G V M
AU  - Russel MGVM
AD  - Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, 
      The Netherlands.
FAU - Romkens, T E H
AU  - Romkens TEH
AD  - Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's 
      Hertogenbosch, The Netherlands.
FAU - West, R L
AU  - West RL
AD  - Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, 
      Rotterdam, The Netherlands.
FAU - Jansen, J M
AU  - Jansen JM
AD  - Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, 
      Amsterdam, The Netherlands.
FAU - Hoentjen, F
AU  - Hoentjen F
AD  - Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, 
      Radboud University Medical Centre, Nijmegen, The Netherlands.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PL  - England
TA  - J Crohns Colitis
JT  - Journal of Crohn's & colitis
JID - 101318676
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Tumor Necrosis Factor Inhibitors)
RN  - 0 (azathiopurine)
RN  - B72HH48FLU (Infliximab)
RN  - E7WED276I5 (Mercaptopurine)
RN  - FYS6T7F842 (Adalimumab)
SB  - IM
MH  - Adalimumab/adverse effects/*therapeutic use
MH  - Adolescent
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Deprescriptions
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Inflammatory Bowel Diseases/*drug therapy
MH  - Infliximab/adverse effects/*therapeutic use
MH  - Male
MH  - Mercaptopurine/analogs & derivatives/therapeutic use
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Registries
MH  - Remission Induction
MH  - Treatment Failure
MH  - Tumor Necrosis Factor Inhibitors/adverse effects/*therapeutic use
MH  - Young Adult
OTO - NOTNLM
OT  - Elderly
OT  - anti-TNF
OT  - safety
EDAT- 2020/01/25 06:00
MHDA- 2021/06/16 06:00
CRDT- 2020/01/25 06:00
PHST- 2020/01/25 06:00 [pubmed]
PHST- 2021/06/16 06:00 [medline]
PHST- 2020/01/25 06:00 [entrez]
AID - 5715073 [pii]
AID - 10.1093/ecco-jcc/jjaa012 [doi]
PST - ppublish
SO  - J Crohns Colitis. 2020 Jul 30;14(7):888-895. doi: 10.1093/ecco-jcc/jjaa012.