In older patients with inflammatory bowel disease (IBD), tumor necrosis factor alpha antagonist (anti-TNF) therapy and vedolizumab (an integrin receptor antagonist) were found to be comparable with regard to both safety and effectiveness, according to a study published in Alimentary Pharmacology & Therapeutics.
To investigate the safety and efficacy of these agents in older IBD patients (>60 years of age), researchers conducted a retrospective cohort study that included patients with Crohn disease or ulcerative colitis starting treatment with an anti-TNF agent or vedolizumab. The primary outcome measure of the study was infection or malignancy occurrence within 1 year of initiating therapy; efficacy measures included clinical remission at 3, 6, and 12 months. “Multivariable logistic regression models adjusting for relevant confounders estimated odds ratios (OR) and 95% confidence intervals,” the authors explained.
Two-hundred and thirty-four patients were included in the analysis, 131 treated with anti-TNF (infliximab was the most common [N=106]) and 103 treated with vedolizumab; about half had a diagnosis of Crohn disease. Results showed that between the 2 drug classes, there was no significant difference in adverse outcomes; infection (pneumonia was the most common) occurred in 20% of patients treated with anti-TNF and 17% of vedolizumab-treated patients (P=.54). Malignancy (new primary cancer or recurrence of prior cancer) occurred in 3% of anti-TNF-treated patients and 1% of vedolizumab-treated patients (P=.27).
With regard to efficacy, Crohn disease patients in the anti-TNF group were more likely to be in remission at 3 months compared with the vedolizumab arm (OR 2.82, 95% CI 1.18-6.76), however no difference in remission rates was observed at 6 and 12 months, indicating that both drug classes were similarly effective.
The authors concluded that based on the findings of the study “both systemically acting anti‐TNF therapy and gut‐selective anti‐integrin therapy with [vedolizumab] are similarly safe and durable in elderly IBD patients.” They added that “With the growing burden of IBD in older individuals, there is an important need both for prospective studies in elderly IBD patients as well as an effort to include them in clinical trials so that safety and efficacy can be robustly estimated.”
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