Serena Porcari1, Anna Viola1, Ambrogio Orlando2, Antonino Carlo Privitera3, Concetta Ferracane3, Maria Cappello4, Alessandro Vitello4, Sebastiano Siringo5, Gaetano Inserra6, Antonio Magnano7, Filippo Mocciaro8, Roberto Di Mitri8, Nunzio Belluardo9, Oriana Fidanza1, Serena Garufi10, Giovanni Magrì11, Carmelo Bertolami12, Antonio Carroccio13, Fabio Salvatore Macaluso2, Sara Renna2, Marco Ventimiglia2, Angela Alibrandi14, Mario Cottone2, Walter Fries15. 1. Clinical Division for Chronic Bowel Disorders, IBD-UNIT, A.O.U. Policlinico 'G. Martino', Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy. 2. Inflammatory Bowel Disease Unit, A.O.O.R. 'Villa Sofia-Cervello', Palermo, Italy. 3. Inflammatory Bowel Disease Unit, A.O. 'Cannizzaro', Catania, Italy. 4. Gastroenterology and Hepatology Unit, A.O.U. Policlinico 'G. Giaccone', Palermo, Italy. 5. Gastroenterology Unit, A.R.N.A.S. 'Garibaldi', Catania, Italy. 6. Internal Medicine Unit, A.O.U. Policlinico 'Vittorio Emanuele', University of Catania, Catania, Italy. 7. Gastroenterology Unit, A.O.U. Policlinico 'Vittorio Emanuele', Catania, Italy. 8. Gastroenterology and Endoscopy Unit, A.R.N.A.S. 'Civico Di Cristina Benfratelli', Palermo, Italy. 9. Gastroenterology Unit, A.O. 'Guzzardi', Vittoria, Italy. 10. Gastroenterology Unit, A.O.O.R. 'S. Elia- M. Raimondi', Caltanissetta, Italy. 11. Gastroenterology Unit, A.O. 'Santa Marta e S. Venera', Acireale, Italy. 12. Gastroenterology Unit, A.O.O.R. 'Papardo Piemonte', Messina, Italy. 13. Internal Medicine Unit, A.O. 'Giovanni Paolo II', Sciacca, Italy. 14. Department of Economics, University of Messina, Messina, Italy. 15. Clinical Division for Chronic Bowel Disorders, IBD-UNIT, A.O.U. Policlinico 'G. Martino', Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy. fwalter@unime.it.
Abstract
BACKGROUND AND OBJECTIVE: Older people with inflammatory bowel disease (IBD) appear to have a lower response to anti-tumour necrosis factor (TNF) therapy, with more frequent complications than younger patients. The objective of this study was to assess persistence on therapy and the safety of anti-TNF therapy in older patients (aged ≥ 60 years). METHODS: We retrospectively reviewed the database of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD), extracting data regarding IBD patients aged ≥ 60 years and controls < 60 years of age at their first course of anti-TNF treatment. Data concerning persistence on therapy over the first year of treatment (primary objective) together with data on reasons for treatment withdrawal, concomitant diseases and treatments were collected. RESULTS: We identified 114 anti-TNF-naϊve patients aged ≥ 60 years (median age 64 years, range 60-80 years; 47 males) compared with 330 younger controls aged < 60 years (median age 39 years, range 18-59 years; 57 males). Older patients with Crohn's disease (n = 73) showed a significantly lower persistence with every kind of anti-TNF therapy (whether analysed together [p < 0.001] or separately for intravenous and subcutaneous [SC] therapy) than younger controls, whereas older patients with ulcerative colitis (n = 41) showed a lower persistence when combining all kinds of anti-TNF treatment (p = 0.004) and for SC therapy. Secondary failures, infections, and neoplasias, but not primary failure, occurred more frequently in older IBD patients than in younger controls. CONCLUSION: Despite a comparable number of primary failures, older IBD patients treated for the first time with anti-TNF agents showed lower treatment persistence due to higher rates of secondary failure, adverse events, infections, and tumours than younger patients in the first year of follow-up. The reasons for this difference still remain unclear.
BACKGROUND AND OBJECTIVE: Older people with inflammatory bowel disease (IBD) appear to have a lower response to anti-tumour necrosis factor (TNF) therapy, with more frequent complications than younger patients. The objective of this study was to assess persistence on therapy and the safety of anti-TNF therapy in older patients (aged ≥ 60 years). METHODS: We retrospectively reviewed the database of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD), extracting data regarding IBDpatients aged ≥ 60 years and controls < 60 years of age at their first course of anti-TNF treatment. Data concerning persistence on therapy over the first year of treatment (primary objective) together with data on reasons for treatment withdrawal, concomitant diseases and treatments were collected. RESULTS: We identified 114 anti-TNF-naϊve patients aged ≥ 60 years (median age 64 years, range 60-80 years; 47 males) compared with 330 younger controls aged < 60 years (median age 39 years, range 18-59 years; 57 males). Older patients with Crohn's disease (n = 73) showed a significantly lower persistence with every kind of anti-TNF therapy (whether analysed together [p < 0.001] or separately for intravenous and subcutaneous [SC] therapy) than younger controls, whereas older patients with ulcerative colitis (n = 41) showed a lower persistence when combining all kinds of anti-TNF treatment (p = 0.004) and for SC therapy. Secondary failures, infections, and neoplasias, but not primary failure, occurred more frequently in older IBDpatients than in younger controls. CONCLUSION: Despite a comparable number of primary failures, older IBDpatients treated for the first time with anti-TNF agents showed lower treatment persistence due to higher rates of secondary failure, adverse events, infections, and tumours than younger patients in the first year of follow-up. The reasons for this difference still remain unclear.
Authors: Anna Viola; Marco Muscianisi; Fabio S Macaluso; Marco Ventimiglia; Maria Cappello; Antonino C Privitera; Antonio Magnano; Dario Pluchino; Giovanni Magrì; Concetta Ferracane; Filippo Mocciaro; Serena Garufi; Enrica Giuffrida; Giuseppe Costantino; Gabriele Fiocco; Mauro Grova; Laura Guida; Angela Alibrandi; Ambrogio Orlando; Walter Fries Journal: JGH Open Date: 2021-02-02
Authors: Vera E R Asscher; Quirine van der Vliet; Karen van der Aalst; Anniek van der Aalst; Eelco C Brand; Andrea E van der Meulen-de Jong; Bas Oldenburg; Marieke J Pierik; Bas van Tuyl; Nofel Mahmmod; P W Jeroen Maljaars; Herma H Fidder Journal: Int J Colorectal Dis Date: 2020-08-28 Impact factor: 2.571