Older age is associated with higher rate of discontinuation of anti-TNF therapy in patients with inflammatory bowel disease.
Older age is associated with higher rate of discontinuation of anti-TNF therapy in patients with inflammatory bowel disease.
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DOI：
10.1002/ibd.23026
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发表时间：
2013-02
影响因子：
4.9
通讯作者：
Ananthakrishnan, Ashwin N.
中科院分区：
文献类型：
--
作者：
Desai, Amit;Zator, Zachary A.;de Silva, Punyanganie;Nguyen, Deanna D.;Korzenik, Joshua;Yajnik, Vijay;Ananthakrishnan, Ashwin N.
在日益老龄化的人群中，了解使用生物制剂治疗的老年患者的结局变得越来越重要。然而，迄今为止，很少有研究调查了抗TNF治疗在该亚组中的安全性和持久性。这是一项回顾性单中心研究，病例包括年龄> 60岁开始抗TNF治疗的所有IBD患者。从病历审查中确定了克罗恩病（CD）和溃疡性结肠炎（UC）病例。我们的对照组包括年龄小于60岁接受抗TNF治疗的患者和年龄大于60岁接受免疫调节剂治疗的患者。Kaplan-Meier生存估计用于计算继续抗TNF治疗的概率。我们确定了总共54例年龄超过60岁（平均73岁，范围61-97岁）的IBD患者开始抗TNF治疗。其中，共有38例患者（70%）在平均24.1个月后停止抗TNF治疗。在开始治疗12个月后，75%的60岁以上患者仍在使用抗TNF药物，而年轻患者为93%，老年AZA患者为82%（p < 0.05）。与年龄较大的AZA使用者相比，年龄较大的抗TNF使用者仍然更可能需要早期停止治疗（HR 2.21，95% CI 1.29 - 3.78）。开始抗TNF治疗时年龄大于60岁的IBD人群中止治疗的风险较高。他们也可能特别容易感染并发症，需要住院治疗，这表明需要在治疗期间仔细监测。
In increasingly aging populations, awareness of outcomes of older patients treated with biologics is becoming more important. However, few studies to-date have investigated the safety and durability of anti-TNF therapy in this sub-group. This was a retrospective single-center study with cases comprising all IBD patients who commenced anti-TNF treatment at age > 60 years. Cases of Crohn’s disease (CD) and ulcerative colitis (UC) were identified from medical record review. Our controls consisted of patients younger than age 60 years on anti-TNF treatment and patients > 60 years on treatment with immunomodulators. Kaplan-Meier survival estimates were used to calculate the probability of remaining on anti-TNF therapy. We identified a total of 54 IBD patients who initiated anti-TNF therapy over the age of 60 years (mean 73, range 61–97 years). Among these, a total of 38 patients (70%) discontinued anti-TNF therapy after a mean of 24.1 months. At 12 months after initiation, 75% of patients older than age 60 years were still on anti-TNF agents compared to 93% among younger users and 82% among older AZA users (p < 0.05). Compared to older AZA users, older anti-TNF users remained more likely to require early therapy cessation (HR 2.21, 95% CI 1.29 – 3.78). The IBD population older than age 60 at the time of initiation of anti-TNF therapy is at higher risk for discontinuation of therapy. They may also be particularly vulnerable to infectious complications requiring hospitalization suggesting need for careful monitoring during therapy.
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