Sa1182 Single-Center Experience of Vedolizumab in Patients With Inflammatory Bowel Disease: Does Age Matter?

Morganstern, Bradley; Singh, Namita; Targan, Stephan R.; Landers, Carol J.; Nguyen, Minh; Vasiliauskas, Eric A.; Shih, David Q.; Feldman, Edward J.; Ippoliti, Andrew; McGovern, Dermot; Dubinsky, Marla; Rabizadeh, Shervin; Melmed, Gil Y.

doi:10.1016/s0016-5085(15)30822-2

Cited by 6 publications

(3 citation statements)

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“…Early experience in clinical practice (N = 66 IBD patients aged ≥18 years) has shown that older age may correlate with a higher likelihood of vedolizumab response. (87) The mean age of patients who responded to vedolizumab, defined as having abnormal C-reactive protein or elevated physician global assessment score, were significantly older (42.5 vs 25.5 years; P = 0.01) at week 6 and at week 14 (43.6 vs 20.9 years; P = 0.02).…”

Section: Medical Management In Elderly Ibd Patientsmentioning

confidence: 92%

Management of Inflammatory Bowel Disease in the Elderly Patient

Ananthakrishnan

Donaldson

Lasch

et al. 2017

Inflammatory Bowel Diseases

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The population of older patients with inflammatory bowel disease (IBD) continues to grow, partly reflecting the aging global population in general. The debilitating effects of IBD compound age-related decrements in health and functional capacity, and make the medical management of older patients with Crohn’s disease and ulcerative colitis distinctly challenging to clinicians. Here, we review the recent literature describing the pharmacologic management of IBD in this population, with focus on the safety, tolerability, and efficacy of common treatment options, such as steroids, immunomodulators, tumor necrosis factor-α antagonists, and integrin antagonists; surgical interventions in older patients are also discussed. Few studies have systematically and prospectively evaluated the clinical challenges in the medical management of IBD in this patient population, leaving a limited evidence base to which clinicians can turn to for guidance. Treatment patterns may thus be suboptimal. For example, prolonged steroid use in the elderly was found to be common, causing significant morbidity from side effects in a particularly vulnerable population. Finally, within the context of a limited evidence base, we discuss common treatment scenarios to define the parameters within which physicians can individualize care for older patients with IBD. Overall, older IBD patients are at higher risk of adverse events and less treatment responsiveness compared with younger patients, underscoring the need for future studies to fully characterize appropriate treatment courses for this population.

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Section: Medical Management In Elderly Ibd Patientsmentioning

confidence: 92%

Management of Inflammatory Bowel Disease in the Elderly Patient

Ananthakrishnan

Donaldson

Lasch

et al. 2017

Inflammatory Bowel Diseases

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“…Vedolizumab also demonstrates efficacy across different patient age groups, including elderly individuals, in both GEMINI I and post-regulatory studies. 18,25,26 GEMINI I also demonstrated a corticosteroidsparing effect for patients receiving vedolizumab, with 74% of patients experiencing corticosteroid dose reductions and 39% being corticosteroid-free by Week 52 of therapy, compared with 57% and 19% of the patients receiving placebo, respectively. 27 In a French observational study, 45% of patients achieving a clinical response were corticosteroidfree following 14 weeks of vedolizumab therapy.…”

Section: Doctor William J Sandbornmentioning

confidence: 98%

Achieving Treatment Goals in Inflammatory Bowel Disease: The Role of Gut-Selective Therapy

Arnstein

2015

EMJ Gastroenterol

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Despite major advances in the inflammatory bowel disease (IBD) treatment landscape, the management of ulcerative colitis (UC) and Crohn’s disease (CD) continues to pose challenges. There is significant scope to optimise treatment of IBD, and conventional therapies may fail to meet evolving treatment goals. Induction of remission with clinical control of symptoms and maintenance of remission with long-term prevention of disease progression are important considerations for healthcare professionals. The concept of complete remission integrates clinical remission, patient-reported outcomes, and mucosal healing, a key therapeutic goal for disease modification. The anti-integrin vedolizumab has been proven to be effective in inducing and maintaining clinical remission in IBD, both first-line and in tumour necrosis factor α (TNFα)-experienced patients, and has demonstrated mucosal healing benefits in UC patients. Safety remains critical for all therapies and vedolizumab is generally well-tolerated across all age groups, including the elderly. Real-world experience with vedolizumab has shown broadly comparable outcomes to the pivotal clinical trials.

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“…Interestingly, older patients administered with vedolizumab (147 patients) had fewer serious infections (<1%) and hospitalizations (11%) than younger patients (Chandar et al 2015). The older patients had a higher response rate (Morganstern et al 2015) with greater CRP reduction at week 6 (42.5 vs. 25.5 years in placebo, p = 0.01) and at week 14 (43.6 vs. 20.9 years in placebo, p = 0.02). No systemic immunosuppression has as yet been reported with vedolizumab.…”

Section: Anti-integrinsmentioning

confidence: 99%

Challenges in the Management of Inflammatory Bowel Disease

Katz¹,

Liu²

2020

Geriatric Gastroenterology

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The initial approach to the management of IBD in the elderly requires authentication of the IBD diagnosis recognizing the potential for confounding multiple diagnosis, e.g., ischemia, radiation, segmental colitis with diverticulitis disease, NSAID use, and GI infection, and multiple comorbidities such as COPD, heart disease, chronic kidney disease, and vascular disease. Further, impact on management along with the need for distinguishing the "fit from frail" elderly helps drive therapeutic decisions. Clinical symptom improvement takes precedence over deep remission, i.e., endoscopic, histologic, and biomarker remission. The overarching threat of infection is of paramount concern and mandates vigilance in maintaining an updated vaccination schedule.

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Sa1182 Single-Center Experience of Vedolizumab in Patients With Inflammatory Bowel Disease: Does Age Matter?

Cited by 6 publications

References 0 publications

Management of Inflammatory Bowel Disease in the Elderly Patient

Management of Inflammatory Bowel Disease in the Elderly Patient

Achieving Treatment Goals in Inflammatory Bowel Disease: The Role of Gut-Selective Therapy

Challenges in the Management of Inflammatory Bowel Disease

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