Older patients starting on anti-TNF agents for their IBD need tighter monitoring for adverse events that contribute to treatment failure, research suggests.
According to a Dutch study of almost 900 patients, patients commencing anti-TNFs from 60 years of age were more likely to stop treatment due to adverse events than younger patients either <40 years of age or 40-59 years.
The study found drug survival after six months was 84.3% in the youngest group, 81.6% in the middle age group and 71.8% in the older group. Corresponding drug survival rates at 12 months were 76.4%, 72.8% and 66.3%.
The incidence rate of serious adverse events in the ≥60 year group was significantly higher than in the <40 age group [IRR 2.06, 95% CI 1.42–3.00, p < 0.001].
In particular the rate of serious infections was almost five times higher in the elderly patient group than the youngest age group (61.2 v 12.4 per 1000 patient years, p<0.001).
Serious infections were defined as those requiring hospitalisation and included pneumonia, urinary sepsis and cholecystitis.
“The higher rate of discontinuation due to treatment failure as well as the higher serious infection rate underline the need for close monitoring for early detection and management of [S]AEs in this patient category,” the study said.
“Nevertheless, in clinical practice, not only the potential risks of AEs associated with anti-TNF treatment but also the risks associated with alternative treatments such as other biologics or surgery should be considered.”
An accompanying editorial in the Journal of Crohn’s and Colitis said there was a paucity of real-world data on the safety of anti-TNF agents in elderly patients with IBD.
And while the study had some limitations, including relatively small numbers in the older age group (n=81), it had relevant implications for clinical practice.
The editorial said the high rate of infections highlighted the need for tight monitoring in older patients receiving TNF inhibitors.
“Such an approach might result in early recognition and timely management of side effects, especially infections, which will further improve treatment outcomes.”