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Anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events
PURPOSE: To assess safety and effectiveness of anti-tumor necrosis factor (anti-TNF) therapy in IBD patients ≥ 60 years. METHODS: Ninety IBD patients ≥ 60 years at initiation of anti-TNF therapy, 145 IBD patients ≥ 60 years without anti-TNF therapy and 257 IBD patients < 60 years at initiation of...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648742/ https://www.ncbi.nlm.nih.gov/pubmed/32860081 http://dx.doi.org/10.1007/s00384-020-03716-6 |
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author | Asscher, Vera E. R. van der Vliet, Quirine van der Aalst, Karen van der Aalst, Anniek Brand, Eelco C. van der Meulen-de Jong, Andrea E. Oldenburg, Bas Pierik, Marieke J. van Tuyl, Bas Mahmmod, Nofel Maljaars, P. W. Jeroen Fidder, Herma H. |
author_facet | Asscher, Vera E. R. van der Vliet, Quirine van der Aalst, Karen van der Aalst, Anniek Brand, Eelco C. van der Meulen-de Jong, Andrea E. Oldenburg, Bas Pierik, Marieke J. van Tuyl, Bas Mahmmod, Nofel Maljaars, P. W. Jeroen Fidder, Herma H. |
author_sort | Asscher, Vera E. R. |
collection | PubMed |
description | PURPOSE: To assess safety and effectiveness of anti-tumor necrosis factor (anti-TNF) therapy in IBD patients ≥ 60 years. METHODS: Ninety IBD patients ≥ 60 years at initiation of anti-TNF therapy, 145 IBD patients ≥ 60 years without anti-TNF therapy and 257 IBD patients < 60 years at initiation of anti-TNF therapy were retrospectively included in this multicentre study. Primary outcome was the occurrence of severe adverse events (SAEs), serious infections and malignancies. Secondary outcome was effectiveness of therapy. Cox regression analyses were used to assess differences in safety and effectiveness. In safety analyses, first older patients with and without anti-TNF therapy and then older and younger patients with anti-TNF therapy were assessed. RESULTS: In older IBD patients, the use of anti-TNF therapy was associated with serious infections (aHR 3.920, 95% CI 1.185–12.973, p = .025). In anti-TNF-exposed patients, cardiovascular disease associated with serious infections (aHR 3.279, 95% CI 1.098–9.790, p = .033) and the presence of multiple comorbidities (aHR 9.138 (1.248–66.935), p = .029) with malignancies, while patient age did not associate with safety outcomes. Effectiveness of therapy was not affected by age or comorbidity. CONCLUSION: Older patients receiving anti-TNF therapy have a higher risk of serious infections compared with older IBD patients without anti-TNF therapy, but not compared with younger patients receiving anti-TNF therapy. However, in anti-TNF-exposed patients, comorbidity was found to be an indicator with regards to SAEs. Effectiveness was comparable between older and younger patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00384-020-03716-6) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7648742 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-76487422020-11-10 Anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events Asscher, Vera E. R. van der Vliet, Quirine van der Aalst, Karen van der Aalst, Anniek Brand, Eelco C. van der Meulen-de Jong, Andrea E. Oldenburg, Bas Pierik, Marieke J. van Tuyl, Bas Mahmmod, Nofel Maljaars, P. W. Jeroen Fidder, Herma H. Int J Colorectal Dis Original Article PURPOSE: To assess safety and effectiveness of anti-tumor necrosis factor (anti-TNF) therapy in IBD patients ≥ 60 years. METHODS: Ninety IBD patients ≥ 60 years at initiation of anti-TNF therapy, 145 IBD patients ≥ 60 years without anti-TNF therapy and 257 IBD patients < 60 years at initiation of anti-TNF therapy were retrospectively included in this multicentre study. Primary outcome was the occurrence of severe adverse events (SAEs), serious infections and malignancies. Secondary outcome was effectiveness of therapy. Cox regression analyses were used to assess differences in safety and effectiveness. In safety analyses, first older patients with and without anti-TNF therapy and then older and younger patients with anti-TNF therapy were assessed. RESULTS: In older IBD patients, the use of anti-TNF therapy was associated with serious infections (aHR 3.920, 95% CI 1.185–12.973, p = .025). In anti-TNF-exposed patients, cardiovascular disease associated with serious infections (aHR 3.279, 95% CI 1.098–9.790, p = .033) and the presence of multiple comorbidities (aHR 9.138 (1.248–66.935), p = .029) with malignancies, while patient age did not associate with safety outcomes. Effectiveness of therapy was not affected by age or comorbidity. CONCLUSION: Older patients receiving anti-TNF therapy have a higher risk of serious infections compared with older IBD patients without anti-TNF therapy, but not compared with younger patients receiving anti-TNF therapy. However, in anti-TNF-exposed patients, comorbidity was found to be an indicator with regards to SAEs. Effectiveness was comparable between older and younger patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00384-020-03716-6) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-08-28 2020 /pmc/articles/PMC7648742/ /pubmed/32860081 http://dx.doi.org/10.1007/s00384-020-03716-6 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Article Asscher, Vera E. R. van der Vliet, Quirine van der Aalst, Karen van der Aalst, Anniek Brand, Eelco C. van der Meulen-de Jong, Andrea E. Oldenburg, Bas Pierik, Marieke J. van Tuyl, Bas Mahmmod, Nofel Maljaars, P. W. Jeroen Fidder, Herma H. Anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events |
title | Anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events |
title_full | Anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events |
title_fullStr | Anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events |
title_full_unstemmed | Anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events |
title_short | Anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events |
title_sort | anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648742/ https://www.ncbi.nlm.nih.gov/pubmed/32860081 http://dx.doi.org/10.1007/s00384-020-03716-6 |
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