Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.
Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York.
Aliment Pharmacol Ther. 2019 Apr;49(7):873-879. doi: 10.1111/apt.15177. Epub 2019 Feb 17.
The older patient group with inflammatory bowel diseases (IBD) is particularly vulnerable to consequences of disease and therapy-related side effects but little is known about the best treatment options in this population.
To compare safety and efficacy of tumor necrosis factor α antagonist (anti-TNF) or vedolizumab (VDZ) in patients with IBD >60 years of age.
This retrospective study included patients with Crohn's disease (CD) or ulcerative colitis (UC) initiating anti-TNF or VDZ therapy ≥60 years of age at three study sites. We examined occurrence of infection or malignancy within 1 year after therapy as our primary outcome. Our efficacy outcomes included clinical remission at 3, 6 and 12 months. Multivariable logistic regression models adjusting for relevant confounders estimated odds ratios (OR) and 95% confidence intervals.
The study included 131 anti-TNF and 103 VDZ initiated patients (age range 60-88 years). Approximately half had CD. At 1 year, there were no significant differences in safety profile between the two therapeutic classes. Infections were observed in 20% of anti-TNF-treated and 17% of VDZ-treated patients (P = 0.54). Pneumonia was the most common infection in both groups. While more anti-TNF-treated CD patients were in remission at 3 months compared to VDZ (OR 2.82, 95% CI 1.18-6.76), this difference was not maintained at 6 and 12 months suggesting similar efficacy of both classes.
Both anti-TNF and VDZ therapy were similarly effective and safe in elderly IBD patients.
炎症性肠病（IBD）的老年患者群体特别容易受到疾病和治疗相关副作用的影响，但对于该人群的最佳治疗选择知之甚少。
比较肿瘤坏死因子 α 拮抗剂（抗 TNF）或 vedolizumab（VDZ）在年龄>60 岁的 IBD 患者中的安全性和疗效。
这项回顾性研究纳入了在三个研究地点接受抗 TNF 或 VDZ 治疗≥60 岁的克罗恩病（CD）或溃疡性结肠炎（UC）患者。我们将治疗后 1 年内发生感染或恶性肿瘤作为主要观察终点。我们的疗效终点包括治疗后 3、6 和 12 个月的临床缓解。使用多变量逻辑回归模型调整相关混杂因素后，估计比值比（OR）及其 95%置信区间。
研究纳入了 131 例接受抗 TNF 和 103 例接受 VDZ 治疗的患者（年龄范围为 60-88 岁）。大约一半患者患有 CD。在 1 年时，两种治疗方法的安全性特征无显著差异。抗 TNF 治疗组中 20%的患者和 VDZ 治疗组中 17%的患者发生感染（P=0.54）。两组中最常见的感染是肺炎。虽然在治疗 3 个月时，接受抗 TNF 治疗的 CD 患者缓解率高于 VDZ（OR 2.82，95%CI 1.18-6.76），但这种差异在 6 个月和 12 个月时并未维持，提示两种药物的疗效相当。
在老年 IBD 患者中，抗 TNF 和 VDZ 治疗均具有相似的疗效和安全性。
