Inflammatory Bowel Diseases

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Inflammatory Bowel Diseases:
doi: 10.1002/ibd.23026
Original Clinical Articles

Older Age Is Associated with Higher Rate of Discontinuation of Anti-TNF Therapy in Patients with Inflammatory Bowel Disease

Desai, Amit MD*; Zator, Zachary A. MD*; de Silva, Punyanganie MB, BS, MRCP*,†; Nguyen, Deanna D. MD*,†; Korzenik, Joshua MD*,†; Yajnik, Vijay MD, PhD*,†; Ananthakrishnan, Ashwin N. MD, MPH*,†

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Background: In increasingly aging populations, awareness of outcomes of older patients treated with biologics is becoming more important. However, few studies to date have investigated the safety and durability of anti-tumor necrosis factor (TNF) therapy in this subgroup.

Methods: This was a retrospective single-center study with cases comprising all IBD patients who began anti-TNF treatment at age >60 years. Cases of Crohn's disease (CD) and ulcerative colitis (UC) were identified from medical record review. Our controls consisted of patients younger than age 60 years on anti-TNF treatment and patients >60 years on treatment with immunomodulators. Kaplan–Meier survival estimates were used to calculate the probability of remaining on anti-TNF therapy.

Results: We identified a total of 54 IBD patients who initiated anti-TNF therapy over the age of 60 years (mean 73, range 61–97 years). Among these, a total of 38 patients (70%) discontinued anti-TNF therapy after a mean of 24.1 months. At 12 months after initiation, 75% of patients older than age 60 years were still on anti-TNF agents compared to 93% among younger users and 82% among older AZA users (P < 0.05). Compared to older AZA users, older anti-TNF users remained more likely to require early therapy cessation (hazard ratio 2.21, 95% confidence interval 1.29–3.78).

Conclusions: The IBD population older than age 60 at the time of initiation of anti-TNF therapy is at higher risk for discontinuation of therapy. They may also be particularly vulnerable to infectious complications requiring hospitalization, suggesting the need for careful monitoring during therapy.

© Crohn's & Colitis Foundation of America, Inc.

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