Gastroenterology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
Unit of Geriatrics, Department of Biomedical and Dental Science and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy.
Cells. 2023 Jun 26;12(13):1722. doi: 10.3390/cells12131722.
With the introduction of more and more monoclonal antibodies selectively targeting various mediators of the immune system, together with Janus-Kinase (JAK)-inhibitors with variable affinities towards different JAK subtypes, the available therapeutic options for the treatment of inflammatory bowel diseases (IBD) have undergone an acceleration in the last five years. On the other hand, the prevalence of IBD patients over 65-years-old is steadily increasing, and, with this, there is a large population of patients that presents more comorbidities, polypharmacy, and, more frequently, frailty compared to younger patients, exposing them to potentially major risks for adverse events deriving from newer therapies, e.g., infections, cardiovascular risks, and malignancies. Unfortunately, pivotal trials for the commercialization of new therapies rarely include older IBD patients, and those with serious comorbidities are virtually excluded. In the present review, we focus on existing literature from pivotal trials and real-world studies, analyzing data on efficacy/effectiveness and safety of newer therapies in older IBD patients with special emphasis on comorbidities and frailty, two distinct but intercorrelated aspects of the older population since age by itself seems to be of minor importance.
随着越来越多的针对免疫系统各种介质的单克隆抗体以及对不同 JAK 亚型具有不同亲和力的 Janus 激酶 (JAK)抑制剂被引入，治疗炎症性肠病 (IBD)的可用治疗选择在过去五年中加速发展。另一方面，65 岁以上的 IBD 患者的患病率稳步上升，与此相伴的是，与年轻患者相比，这一人群中有更多的合并症、多种药物治疗，并且更容易出现虚弱，这使他们面临着来自新型治疗方法的潜在重大不良事件风险，例如感染、心血管风险和恶性肿瘤。不幸的是，新疗法商业化的关键试验很少包括老年 IBD 患者，而那些有严重合并症的患者实际上被排除在外。在本综述中，我们重点关注关键试验和真实世界研究中的现有文献，分析新疗法在有特殊合并症和虚弱的老年 IBD 患者中的疗效/有效性和安全性数据，这两个方面是老年人群中两个不同但相互关联的方面，因为年龄本身似乎并不重要。
