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Current Treatment Options in Gastroenterology

Erschienen in:

23.10.2020 | Gastroenterology for Geriatric Patients (S Katz and A Afzali, Section Editors)

Biologic Therapy in Elderly Patients with IBD: Current Trends and Special Management Considerations

verfasst von: Joshua M. Steinberg, MD, Yara Sarkis, MD, Samuel J. Kallus, MD, Aline Charabaty, MD

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 4/2020

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Abstract

Purpose of review

With the aging IBD population and increasing incidence of elderly-onset IBD, the overall prevalence of IBD in the elderly is rising. The elderly have unique medical, psychosocial, and other age-related comorbidities and disabilities that need to be taken into account when assessing the impact of IBD on the patient’s overall health and quality of life, and choosing an effective therapy.

Recent findings

There is a general reluctance among physicians to prescribe biologic therapies out of concerns of their potential side effects, in favor of mesalamine, steroids, and surgery. Although there is an overall paucity of robust data on biologic use in the elderly from randomized clinical trials, recent retrospective and real-world studies provide insight on the safety and efficacy of anti-TNF and other biologics in this population.

Summary

This review analyzes and highlights the most recent data on biologic therapies in the elderly, so physicians can make informed decisions and judiciously use biologics in the elderly with moderate to severe IBD, keeping in mind the goals of care in this population, i.e., effectively and safely control IBD symptoms, minimize steroid use, prevent short-term disease complications and hospitalization, restore the patient’s quality of life and functionality, and prevent further frailty and disability.

Dahlhamer JM, Zammitti EP, Ward BW, Wheaton AG, Croft JB. Prevalence of inflammatory bowel disease among adults aged ≥18 years—United States, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(42):1166–9 https://www.cdc.gov/mmwr/volumes/65/wr/mm6542a3.htm.CrossRef

Sairenji T, Collins KL, Evans DV. An update on inflammatory bowel disease. Prim Care Clin Off Pract. 2017;44(4):673–92.CrossRef

Sturm A, Maaser C, Mendall M, Karagiannis D, Karatzas P, Ipenburg N, et al. European Crohn’s and colitis organisation topical review on IBD in the elderly. J Crohns Colitis. 2016;11(3):263–273. https://doi.org/10.1093/ecco-jcc/jjw188

Jeuring SFG, van den Heuvel TRA, Zeegers MP, Hameeteman WH, Romberg-Camps MJL, Oostenbrug LE, et al. Epidemiology and long-term outcome of inflammatory bowel disease diagnosed at elderly age—an increasing distinct entity? Inflamm Bowel Dis. 2016;22(6):1425–34.CrossRef

Dorreen A, Heisler C, Jones J. Treatment of inflammatory bowel disease in the older patient. Inflamm Bowel Dis. 2018;24(6):1155–66.CrossRef

Ananthakrishnan A. Epidemiology and risk factors for IBD. Nat Rev Gastroenterol Hepatol. 2015;12:205–17. https://doi.org/10.1038/nrgastro.2015.34.CrossRefPubMed

• Charpentier C, Salleron J, Savoye G, et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut. 2014;63(3):423–432. https://doi.org/10.1136/gutjnl-2012-3038. IBD Dutch cohort that found the rate of surgery in CD and UC and the rate of CD complications in elderly-onset IBD were similar to that of adult-onset IBD, while the risk of UC requiring hospitalization was higher.

• Ananthakrishnan AN, Shi HY, Tang W, et al. Systematic review and meta-analysis: phenotype and clinical outcomes of older-onset inflammatory bowel disease. J Crohns Colitis. 2016;10(10):1224–1236. https://doi.org/10.1093/ecco-jcc/jjw054. Found that elderly IBD patients present with less complicated disease, but describes higher colectomy rate early after diagnosis in older-onset UC compared to younger-onset.

Taleban S, Colombel J-F, Mohler MJ, Fain MJ. Inflammatory bowel disease and the elderly: a review. J Crohns Colitis. 2015;9(6):507–15.CrossRef

10.

Ng SC, Tang W, Ching JY, Wong M, Chow CM, Hui AJ, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-Pacific Crohn’s and colitis epidemiology study. Gastroenterology. 2013;145(1):158–165.e2.CrossRef

11.

Hruz P, Juillerat P, Kullak-Ublick G-A, Schoepfer AM, Mantzaris GJ, Rogler G. Management of the elderly inflammatory bowel disease patient. Digestion. 2020;14:1–15.

12.

Khan N, Vallarino C, Lissoos T, Darr U, Luo M. Risk of infection and types of infection among elderly patients with inflammatory bowel disease: a retrospective database analysis. Inflamm Bowel Dis. 2019;26(3):462–468. https://doi.org/10.1093/ibd/izz065

13.

Juneja M, Baidoo L, Schwartz MB, et al. Geriatric inflammatory bowel disease: phenotypic presentation, treatment patterns, nutritional status, outcomes, and comorbidity. Dig Dis Sci. 2012;57(9):2408–15. https://doi.org/10.1007/s10620-012-2083-x.CrossRefPubMed

14.

Everhov ÅH, Halfvarson J, Myrelid P, Sachs MC, Nordenvall C, Söderling J, et al. Incidence and treatment of patients diagnosed with inflammatory bowel diseases at 60 years or older in Sweden. Gastroenterology. 2018;154(3):518–528.e15.CrossRef

15.

Limdi JK. Aminosalicylates and elderly-onset colonic Crohn’s disease—more than meets the eye? J Crohns Colitis. 2017;11(8):1022–2.

16.

Johnson SL, Bartels CM, Palta M, Thorpe CT, Weiss JM, Smith MA. Biological and steroid use in relationship to quality measures in older patients with inflammatory bowel disease: a US Medicare cohort study. BMJ Open. 2015;5(9):e008597.CrossRef

17.

Brassard P, Bitton A, Suissa A, Sinyavskaya L, Patenaude V, Suissa S. Oral corticosteroids and the risk of serious infections in patients with elderly-onset inflammatory bowel diseases. Am J Gastroenterol. 2014;109(11):1795–802.CrossRef

18.

Calafat M, Mañosa M, Cañete F, Ricart E, Iglesias E, Calvo M, et al. Increased risk of thiopurine-related adverse events in elderly patients with IBD. Aliment Pharmacol Ther. 2019 Oct 1;50(7):780–8.

19.

Abbas AM, Almukhtar RM, Loftus EV, Lichtenstein GR, Khan N. Risk of melanoma and non-melanoma skin cancer in ulcerative colitis patients treated with thiopurines: a nationwide retrospective cohort. Am J Gastroenterol. 2014;109(11):1781–93.CrossRef

20.

Bourrier A, Carrat F, Colombel J-F, Bouvier A-M, Abitbol V, Marteau P, et al. Excess risk of urinary tract cancers in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Aliment Pharmacol Ther. 2016 Jan 1;43(2):252–61.

21.

Tran V, Limketkai BN, Sauk JS. IBD in the elderly: management challenges and therapeutic considerations. Curr Gastroenterol Rep. 2019;21(11):60.CrossRef

22.

Butter M, Weiler S, Biedermann L, Scharl M, Rogler G, Bischoff-Ferrari HA, et al. Clinical manifestations, pathophysiology, treatment and outcome of inflammatory bowel diseases in older people. Maturitas. 2018 Apr;110:71–8.

23.

• Cottone M, Kohn A, Daperno M, et al. Advanced age is an independent risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol. 2011;9(1):30–35. doi:https://doi.org/10.1016/j.cgh.2010.09.0267;374(9701):1617-25. Retrospective study that found that older patients on anti-TNF had an increased risk of severe infection (11% vs 0.5% vs 2.6% respectively) and mortality (10% vs 2% vs 1% respectively) compared to younger patients on anti-TNF or older patients not on biologic therapy. The risk of malignancy in elderly on anti-TNF, younger patients on anti-TNF and older patients not on biologic was 3%, 2% and none respectively.

24.

Borren NZ, Ananthakrishnan AN. Safety of biologic therapy in older patients with immune-mediated diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019;17(9):1736–1743.e4.CrossRef

25.

• Tofani C, Aberra F, Tierney A, Gr L. Infections in IBD patients on immunomodulators, corticosteroids, and anti-TNF therapy: is elderly age a predictor? Clin Med Investig [Internet]. 2016 [cited 2020 May 12];1(2). Available from: https://oatext.com/Infections-in-IBD-Patients-on-Immunomodulators-Corticosteroids-and-Anti-TNF-therapy-Is-Elderly-Age-a-Predictor.php. This study found that anti-TNF or immunomodulators alone did not significantly increase the risk of infection in the elderly; however the infection rate ratio in the elderly when corticosteroids were added to anti-TNF was 10.64 (95% CI=1.95, 58.10), or added to thiopurines was 10.58 (95% CI = 1.27, 87.91), highlighting that the infectious risk in the elderly patients on anti-TNF or immunomodulator was mainly driven by concomitant corticosteroid use.

26.

Lewis JD, Scott FI, Brensinger CM, Roy JA, Osterman MT, Mamtani R, et al. Increased mortality rates with prolonged corticosteroid therapy when compared with antitumor necrosis factor-α-directed therapy for inflammatory bowel disease. Am J Gastroenterol. 2018;113(3):405–17. https://doi.org/10.1038/ajg.2017.479.CrossRefPubMedPubMedCentral

27.

Cheddani H, Luc D, Fumery M, Charpentier C, Bouvier AM, Dupas J-L, et al. Cancer in elderly onset inflammatory bowel disease: a population-based study. American Journal of Gastroenterology. 2016;111(10):1428–36. https://doi.org/10.1038/ajg.2016.304.CrossRef

28.

Mañosa M, Chaparro M, Juan A, Aràjol C, Alfaro I, Mínguez M, et al. Immunomodulatory therapy does not increase the risk of cancer in persons with inflammatory bowel disease and a history of extracolonic cancers. The American journal of gastroenterology. 2019;114(5):771–6. https://doi.org/10.14309/ajg.0000000000000210.CrossRefPubMed

29.

Raaschou P, Frisell T, Askling J, ARTIS Study Group. TNF inhibitor therapy and risk of breast cancer recurrence in patients with rheumatoid arthritis: a nationwide cohort study. Ann Rheum Dis. 2015;74(12):2137–43. https://doi.org/10.1136/annrheumdis-2014-205745.CrossRefPubMed

30.

• Lobatón T, Ferrante M, Rutgeerts P, Ballet V, Van Assche G, Vermeire S. Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2015 Aug 1;42(4):441–51. Study found that short-term clinical response (evaluated at 10 weeks) was higher in a younger anti-TNF group (68% vs. 89%; P < 0.001), but there was no statistically significant difference in long term efficacy (evaluated at 6 months or more) among the younger and elderly groups.

31.

de Jong ME, Smits LJT, van Ruijven B, den Broeder N, Russel MGVM, Römkens TEH, et al. Increased discontinuation rates of anti-TNF therapy in elderly inflammatory bowel disease patients. J Crohns Colitis [Internet]. 2020 Jan 24 [cited 2020 Dec 5];(jjaa012). Available from: https://doi.org/10.1093/ecco-jcc/jjaa012, 14, 888, 895.

32.

Colombel JF, Sands BE, Rutgeerts P, Sandborn W, Danese S, D'Haens G, et al. The safety of vedolizumab for ulcerative colitis and Crohn’s disease. Gut. 2017;66(5):839–51. https://doi.org/10.1136/gutjnl-2015-311079.CrossRefPubMed

33.

•• Adar T, Faleck D, Sasidharan S, Cushing K, Borren NZ, Nalagatla N, et al. Comparative safety and effectiveness of tumor necrosis factor α antagonists and vedolizumab in elderly IBD patients: a multicentre study. Aliment Pharmacol Ther. 2019;49(7):873–9. A multicenter retrospective study compared the one-year safety and efficacy of anti-TNF and VDZ in elderly with IBD, between the ages of 60-88 years. There were no significant differences in the safety profile between the two therapeutic classes (131 anti-TNF and 103 VDZ initiated patients) at one year: the incidence of infections was similar between the two groups (20% of anti-TNF-treated and 17% of VDZ-treated patients, p = 0.54), with the most common infection being pneumonia.

34.

• Cohen NA, Plevris N, Kopylov U, Grinman A, Ungar B, Yanai H, … Maharshak N (2020) Vedolizumab is effective and safe in elderly inflammatory bowel disease patients: a binational, multicenter, retrospective cohort study. United Eur Gastroenterol J. https://doi.org/10.1177/2050640620951400. - retrospective multicenter study comparing the efficacy and safety of VDZ among patients younger than 40 and patients older than 60 demonstrating similar efficacy however there was a statistically significant (p=.002) higher incidence of infections in the elderly group (12%) compared to the younger group (2%).

35.

Yajnik V, Khan N, Dubinsky M, Axler J, James A, Abhyankar B, et al. Efficacy and safety of vedolizumab in ulcerative colitis and Crohn’s disease patients stratified by age. Adv Ther. 2017;34(2):542–59.CrossRef

36.

Ibraheim H, Samaan M, Srinivasan A, Brain O, Digby-Bell J, Irving P, et al. Effectiveness and safety of vedolizumab in inflammatory bowel disease patients aged 60 and over: an observational multicenter UK experience. Annals of Gastroenterology. 2020;33:1–10.

37.

Patel DB, Cohen E, Ha C. P1431 - Efficacy of vedolizumab in older IBD patients based on prior biologic exposure. Program No. P1431. ACG 2019 Annual Scientific Meeting Abstracts.

38.

Patel H, Latremouille-Viau D, Burne R, Shi S, Adsul S. Comparison of real-world treatment outcomes with vedolizumab versus infliximab in biologic-naive patients with inflammatory bowel disease, Crohn’s & Colitis 360, 2019;1(2): otz022, https://doi.org/10.1093/crocol/otz022.

39.

Feagan BG, Sandborn WJ, Gasink C, Jacobstein D, Lang Y, Friedman JR, et al. Ustekinumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2016;375(20):1946–60.CrossRef

40.

Sands BE, Sandborn WJ, Panaccione R, O’Brien CD, Zhang H, Johanns J, et al. Ustekinumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2019;381(13):1201–14.CrossRef

41.

Iwamoto M, Kato K, Moriyama M. Elderly-onset Crohn’s disease remarkably responsive to ustekinumab: a case report. Int J Color Dis. 2020;35:355–9. https://doi.org/10.1007/s00384-019-03476-y.CrossRef

42.

Godat S, Fournier N, Safroneeva E, Juillerat P, Nydegger A, Straumann A, et al. Frequency and type of drug-related side effects necessitating treatment discontinuation in the Swiss Inflammatory Bowel Disease Cohort. Eur J Gastroenterol Hepatol. 2018;30(6):612–20.CrossRef

Titel: Biologic Therapy in Elderly Patients with IBD: Current Trends and Special Management Considerations
verfasst von: Joshua M. Steinberg, MD
Yara Sarkis, MD
Samuel J. Kallus, MD
Aline Charabaty, MD
Publikationsdatum: 23.10.2020
Verlag: Springer US
Erschienen in: Current Treatment Options in Gastroenterology / Ausgabe 4/2020
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI: https://doi.org/10.1007/s11938-020-00309-8

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