Vedolizumab as first-line biological therapy in elderly patients and those with contraindications for anti-TNF therapy: a real-world, nationwide cohort of patients with inflammatory bowel diseases

Attauabi, Mohamed; Höglund, Camilla; Fassov, Janne; Pedersen, Kenneth Bo; Hansen, Heidi Bansholm; Wildt, Signe; Jensen, Michael D.; Neumann, A; Lind, Cecilie; Jacobsen, Helle J.; Popa, Anamaria; Kjeldsen, Jens; Pedersen, Natalia; Molazahi, Akbar; Haderslev, Kent V.; Aalykke, Claus; Knudsen, Torben; Cebula, Wojciech; Munkholm, Pia; Bendtsen, Flemming; Seidelin, Jakob Benedict; Burisch, Johan

doi:10.1080/00365521.2021.1946588

Cited by 13 publications

(29 citation statements)

References 34 publications

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“…This may not be surprising as some patients with elderly onset IBD will initiate vedolizumab because of fear of side effects from other types of biologics. 22,23 Former data on corticosteroids in elderly patients TA B L E 4 Crude and adjusted hazard ratios according to stop of medical treatments in elderly patients within the first year after initiation of the medical therapy. Cox regression analyses were performed with reference group being patients with adult-onset inflammatory bowel disease (IBD).…”

Section: Discussionmentioning

confidence: 99%

“…The use of vedolizumab was markedly higher in elderly patients compared to those with adult onset. This may not be surprising as some patients with elderly onset IBD will initiate vedolizumab because of fear of side effects from other types of biologics 22,23 . Former data on corticosteroids in elderly patients have been conflicting 3,6,21 .…”

Section: Discussionmentioning

confidence: 99%

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Patients with elderly onset inflammatory bowel disease have a decreased chance of initiation of all types of medications and increased risk of surgeries—A nationwide cohort study

Nørgård

Zegers

Knudsen

et al. 2023

Aliment Pharmacol Ther

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Summary Objective In patients with elderly (≥60 years) onset inflammatory bowel disease (IBD), we studied initiation of medications, drug persistency and surgeries. Design A nationwide cohort study based on Danish registries, comprising incident IBD patients ≥18 years from 1995 to 2020 (N = 69,039). Patients were divided into elderly (N = 19,187) and adult onset (N = 49,852). Outcomes were initiation of thiopurines, 5‐ASA, biologics and corticosteroids within 1 and 5 years after diagnosis, and for those who initiated medications, we estimated drug persistency. Surgeries were examined within 1 and 5 years. We used regression models controlling for covariates. Results In elderly patients, the adjusted hazard ratios (aHR) for initiating thiopurines, 5‐ASA and biologics within 1 year were 0.44 (95% CI 0.42–0.47), 0.77 (95% CI 0.75–0.79) and 0.29 (95% CI 0.26–0.31) respectively. The results were similar within 5 years. In elderly patients, drug persistency for thiopurines, 5‐ASA and biologics was not impaired within 5 years. The aHR of stopping steroids within 1 and 5 years were 0.80 (95% CI 0.76–0.84) and 0.77 (95% CI 0.74–0.80) respectively. The risk of surgeries was increased in the elderly patients (in ulcerative colitis, within 5 years, aHR 1.39 [95% CI 1.27–1.52], and in Crohn's disease 1.13 [95% CI 1.04–1.23]). Conclusion We found significantly low chance of initiation of IBD medications in elderly patients, the reason may not be due to mild disease course. In elderly patients, drug persistency was comparable to adults. Clinicians should carefully consider whether they underuse IBD‐specific medications in elderly patients, and special attention should be applied to timely discontinuation of corticosteroids.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patients with elderly onset inflammatory bowel disease have a decreased chance of initiation of all types of medications and increased risk of surgeries—A nationwide cohort study

Nørgård

Zegers

Knudsen

et al. 2023

Aliment Pharmacol Ther

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“…The cut-off age for the elderly population differed among the studies utilized for analysis. Individuals were classified as elderly with an age of ≥ 60 years in seven studies, 18,[25][26][27][28][29][30] ≥ 65 years in three studies, 9,31,32 while the median age for the elderly cohort in one study was 66 years. 33 From a study design perspective, our analysis included five multicenter retrospective, 18,25,27,28,33 two single-center retrospective, 26,30 and one each of multicenter prospectiveretrospective, 31 retrospective case-control, 9 retrospective analysis of the Danish cohort, 29 and a post hoc analysis of the GEMINI clinical trials.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

Safety and Effectiveness of Vedolizumab in Elderly Patients with Inflammatory Bowel Disease

Dahiya

Chandan

Bapaye

et al. 2023

Journal of Clinical Gastroenterology

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Background: There is limited data on Vedolizumab utilization in elderly patients. Our study aims to assess the effectiveness and safety of Vedolizumab in this subset population.Materials and Methods: Databases including Cochrane Central, Embase, Medline (via Ovid), Scopus, and Web of Science were searched in August 2022 to identify studies that assessed Vedolizumab therapy in elderly patients. Pooled proportion and risk ratios (RR) were calculated.Results: Total 11 studies with 3546 IBD patients (1314 elderly and 2232 young) were included in the final analysis. Pooled rate of overall and serious infections in the elderly cohort was 8.45% (95% CI = 6.27-11.29; I 2 23%) and 2.59% (95% CI = 0.78-8.29; I 2 76%), respectively. However, there was no difference in overall infection rates between elderly and young patients. Pooled rate of endoscopic, clinical, and steroid-free remission for elderly IBD patients was 38.45% (95% CI = 20.74-59.56; I 2 93%), 37.95% (95% CI = 33.08-43.06; I 2 13%), and 38.8% (95% CI = 31.6-46.4; I 2 77%), respectively.Elderly patients had lower steroid-free remission rates [RR 0.85, 95% CI = 0.74-0.99; I 2 0%, P = 0.03]; however, there was no difference in rates of clinical (RR 0.86, 95% CI = 0.72-1.03; I 2 0%, P = 0.10) or endoscopic remission (RR 1.06, 95% CI = 0.83-1.35; I 2 0%, P = 0.63) compared with younger patients. Pooled rate of IBD-related surgery and IBD-related hospitalizations was 9.76% (95% CI = 5.81-15.92; I 2 78%) and 10.54% (95% CI = 8.37-13.2; I 2 0%), respectively for the elderly cohort. There was no statistical difference in IBD-related surgeries between elderly and young IBD patients, RR 1.20 (95% CI = 0.79-1.84; I 2 16%), P = 0.4. Conclusions:Vedolizumab is equally safe and effective for clinical and endoscopic remission in elderly and younger populations.

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“…In biologically naïve older UC patients, steroid-free remission at 52 weeks was reported in 40–60% together with good persistence in therapy over time (75% at 52 weeks) [ 58 , 59 ]. A retrospective multicenter comparison between anti-TNF and vedolizumab in older UC patients did not find any difference at 6 and 12 months [ 60 ].…”

Section: Medical Therapy—effectiveness and Persistencementioning

confidence: 99%

Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

et al. 2022

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The number of patients with inflammatory bowel disease (IBD) approaching an older age, together with the number of over-60-year-old patients newly diagnosed with IBD, is steadily increasing, reaching 25% of all patients. The present review focuses on late-onset ulcerative colitis (UC) and its initial disease course in comparison with that observed in younger adults in terms of extension at onset and the risk of proximal disease progression, medical treatment, surgery and hospitalization in the first years after diagnosis. We summarize the clues pointing to a milder disease course in a population which frequently presents major frailty due to comorbidities. With increasing age and thus increasing comorbidities, medical and surgical therapies frequently represent a challenge for treating physicians. The response, persistence, and risks of adverse events of conventional therapies indicated for late onset/older UC patients are examined, emphasizing the risks in this particular population, who are still being treated with prolonged corticosteroid therapy. Finally, we concentrate on data on biotechnological agents for which older patients were mostly excluded from pivotal trials. Real-life data from newer agents such as vedolizumab and ustekinumab show encouraging efficacy and safety profiles in the population of older UC patients.

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Vedolizumab as first-line biological therapy in elderly patients and those with contraindications for anti-TNF therapy: a real-world, nationwide cohort of patients with inflammatory bowel diseases

Cited by 13 publications

References 34 publications

Patients with elderly onset inflammatory bowel disease have a decreased chance of initiation of all types of medications and increased risk of surgeries—A nationwide cohort study

Patients with elderly onset inflammatory bowel disease have a decreased chance of initiation of all types of medications and increased risk of surgeries—A nationwide cohort study

Safety and Effectiveness of Vedolizumab in Elderly Patients with Inflammatory Bowel Disease

Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

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