Risk of immunomediated adverse events and loss of response to infliximab in elderly patients with inflammatory bowel disease. A cohort study of the ENEIDA registry

J Crohns Colitis. 2021 Dec 3:jjab213. doi: 10.1093/ecco-jcc/jjab213. Online ahead of print.

ABSTRACT

BACKGROUND: Immunomediated adverse events (IAEs) are the most frequently reported infliximab-related adverse events. Combination therapy may reduce their incidence, although this strategy is not recommended in elderly patients.

AIMS: To compare the rates of infliximab-related IAE and loss of response (LOR) in elderly and younger patients.

METHODS: Adult patients in the ENEIDA registry who had received a first course of infliximab therapy were identified and grouped into two cohorts regarding age at the beginning of treatment (over 60 and between 18-50 years). The rates of IAEs and LOR were compared.

RESULTS: Nine hundred thirty-nine patients (12%) who started infliximab over 60 years of age and 6,844 (88%) below 50 years of age were included. Elderly patients presented a higher proportion of AEs related to IFX (23.2% vs. 19%; P=0.002), infections (7.1% vs. 4.3%; P<0.001) and neoplasms (2.2% vs. 0.5%; P<0.001). In contrast, the rates of IAE (14.8% vs. 14.8%, P=0.999), infusion reactions (8.1% vs. 8.1%, P=0.989), late hypersensitivity (1.3% vs. 1.2%, P=0.895), paradoxical psoriasis (1% vs. 1.5%; P=0.187) and drug-induced lupus erythematosus (0.6% vs. 0.7%; P=0.947) were similar in elderly and younger patients. LOR rates were also similar between both groups (20.5% vs. 19.3%; P=0.438). In the logistic regression analysis, infliximab monotherapy, extraintestinal manifestations and female gender were the only risk factors for IAEs, whereas infliximab monotherapy, extraintestinal manifestations and Crohn's disease were risk factors for LOR.

CONCLUSIONS: Elderly patients with IBD have a similar risk of developing infliximab-related IAEs and LOR to that of younger patients.

PMID:34864947 | DOI:10.1093/ecco-jcc/jjab213