P314 Elderly onset is associated with low efficacy of anti-TNF treatment in Bio-naïve IBD patients: A multicenter cohort study by the Osaka Gut Forum
Amano, T.(1);Shinzaki, S.(1);Asakura, A.(1);Tashiro, T.(1);Otake, Y.(1);Tani, M.(1);Yoshihara, T.(1);Inoue, T.(1);Takehara, T.(1);
(1)Osaka University Graduate School of Medicine, Department of Gastroenterology and Hepatology, Osaka, Japan; the Osaka Gut Forum
Background
The number of elderly patients with inflammatory bowel disease (IBD) is increasing, but the outcomes of patients with elderly onset (EO) IBD treated with anti-tumor necrosis factor (TNF) remains uncertain. The present study evaluated the efficacy and safety of anti-TNF treatment for bio-naïve EO-IBD.
Methods
This was a multicenter retrospective observational study including bio-naïve patients with IBD who started anti-TNF treatment from 2010 to 2019 at 18 hospitals of the Osaka Gut Forum. Elderly patients were defined as those 60 years and older, and elderly patients with IBD were further divided into those with EO (Elderly-EO) and those with non-elderly onset (Elderly-NEO). The clinical symptoms were evaluated by partial Mayo score (pMayo) for UC and Harvey-Bradshaw index (HBI) for CD, and the clinical remission rate at 52 weeks after the start of treatment was analyzed retrospectively. Clinical remission was defined as pMayo ≤ 2 and each subscore ≤ 1 for UC and HBI ≤ 4 for CD.
Results
A total of 432 patients were enrolled, comprising 55 with Elderly-EO (12.7%), 25 with Elderly-NEO (5.8%), and 352 under age 60 (Non-elderly, 81.5%). After 52 weeks of anti-TNF treatment, clinical and steroid-free remission rates were significantly lower in Elderly-EO than in Non-elderly (37.7% and 60.8%; P = 0.001, and 35.9% and 57.8%; P = 0.003, respectively), and comparable between Elderly-NEO and Non-elderly. Multivariate analysis revealed that elderly onset was a significant factor for both clinical remission [Odds ratio (OR), 0.49, 95% confidence interval (CI), 0.25-0.96] and steroid-free remission [OR, 0.51, 95%CI, 0.26-0.99] after 52 weeks of anti-TNF treatment. The rate of cumulative severe adverse events was significantly lower in Elderly-EO than in Non-elderly (P = 0.007), but comparable between Elderly-NEO and Non-elderly.
Conclusion
Anti-TNF treatment is less effective for bio-naïve EO-IBD than for elderly patients with younger onset and non-elderly, and may raise safety concerns in this group of patients.