Risk of infection in elderly patients with inflammatory bowel disease under biologics: A prospective, multicenter, observational, one-year follow-up comparative study - 27/04/23
Highlights |
• | Biologics are more widely used in elderly patients with inflammatory bowel disease. |
• | Biologics are used with caution in elderly patients given the potential high risk of infections. |
• | Infections in elderly IBD patients under biologics concern around 30 % of patients within one year. |
• | The risk did not differ between those under anti-TNF, vedolizumab or ustekinumab. |
• | The risk of infection appears to be related to comorbidities rather than to biologics or disease activity. |
Summary |
Objectives |
The emergence of biologics has improved the course of inflammatory bowel diseases (IBD) in the elderly population despite a potential higher risk of infections. We conducted a one-year, prospective, multicenter, observational study to determine the frequency of occurrence of at least one infectious event in elderly IBD patients under anti-TNF therapy compared with that in elderly patients under vedolizumab or ustekinumab therapies.
Methods |
All IBD patients over 65 years exposed to anti-TNF, vedolizumab or ustekinumab therapies were included. The primary endpoint was the prevalence of at least one infection during the whole one year follow-up.
Results |
Among the 207 consecutive elderly IBD patients prospectively enrolled, 113 were treated with anti-TNF and 94 with vedolizumab (n=63) or ustekinumab (n=31) (median age 71 years, 112 Crohn's disease). The Charlson index was similar between patients under anti-TNF and those under vedolizumab or ustekinumab as well as the proportion of patients under combination therapy and under concomitant steroid therapy did not differ between both both groups. The prevalence of infections was similar in patients under anti-TNF and in those under vedolizumab or ustekinumab (29% versus 28%, respectively; p=0.81). There was no difference in terms of type and severity of infection and of infection-related hospitalization rate. In multivariate regression analysis, only the Charlson comorbidity index (≥ 1) was identified as a significant and independent risk factor of infection (p=0.03).
Conclusion |
Around 30 % of elderly patients with IBD under biologics experienced at least one infection during the one-year study follow-up period. The risk of occurrence of infection does not differ between anti-TNF and vedolizumab or ustekinumab therapies, and only the associated comorbidity was linked with the risk of infection.
Le texte complet de cet article est disponible en PDF.Keywords : Inflammatory bowel disease, Infection, Biologics, Elderly
Plan
| Guarantor of the article: Anne Bozon/ Romain Altwegg |
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| Specific author contributions: A Bozon: planning and conducting the study, collecting and interpreting data, drafting the manuscript, has approved the final draft submitted. S Nancey: collecting data, drafting the manuscript, has approved the final draft submitted. M Serrero: collecting data, has approved the final draft submitted. L Caillo: collecting data, has approved the final draft submitted. A Benezech: collecting data, has approved the final draft submitted. R Combes: collecting data, has approved the final draft submitted. G Danan: collecting data, has approved the final draft submitted. S Akouete: helping with statistical analysis, has approved the final draft submitted. L Pages: helping with statistical analysis, drafting the manuscript, has approved the final draft submitted. JF Bourgaux: collecting data, has approved the final draft submitted. Guillaume Le Cosquer: collecting data, has approved the final draft submitted. L Boivineau: collecting data, has approved the final draft submitted. M Meszaros: drafting the manuscript, has approved the final draft submitted. R. Altwegg: planning and conducting the study, collecting and interpreting data, drafting the manuscript, has approved the final draft submitted. |
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| Financial support: none. |
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| Conflicts of interest: A Bozon declares no conflict of interest related to this work. S Nancey declares counseling, boards, transports or fees from Abbvie, Biogen, HAC-pharma, Janssen, MSD, Novartis, Pfizer, Takeda, Tillots, BMS, Amgen, and Fresenius. M Serrero declares counseling, boards, transports or fees from Abbvie, Amgen, Ferring, Janssen, MSD, Pfizer, Takeda, Tillotts, Celltrion. L Caillo declares counseling, boards, transports or fees from Abbvie, Amgen, Biogen, Janssen, Pfizer, Takeda, Tillotts. C Gilletta declares counseling, boards, transports or fees from Abbvie, Amgen, Biogen, Ferring, Janssen, MSD, Pfizer, Takeda, Tillotts, Celltrion. A Benezech declares counseling, boards, transports or fees from Abbvie, Amgen, Ferring, Janssen, MSD, Takeda. R Combes declares transports or fees from Abbvie, Amgen, Biogen, Ferring, Janssen, MSD, Pfizer, Takeda. G Danan declares no conflict of interest related to this work. S Akouete declares no conflict of interest related to this work. L Pages declares no conflict of interest related to this work. JF Bourgaux declares no conflict of interest related to this work. L Boivineau declares no conflict of interest related to this work. M Meszaros declares no conflict of interest related to this work. R Altwegg declares counseling, boards, transports or fees from Abbvie, Amgen, Biogen, Ferring, Janssen, MSD, Pfizer, Takeda, Tillotts. |
Vol 47 - N° 5
Article 102107- mai 2023 Retour au numéro
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