Advanced Age Is an Independent Risk Factor for Severe Infections and Mortality in Patients Given Anti-Tumor Necrosis Factor Therapy for Inflammatory Bowel Disease

Mario Cottone, Anna Kohn, Marco Daperno, Alessandro Armuzzi, Luisa Guidi, Renata D'Inca, Fabrizio Bossa, Erika Angelucci, Livia Biancone, Paolo Gionchetti, Sandro Ardizzone, Claudio Papi, Walter Fries, Silvio Danese, Gabriele Riegler, Maria Cappello, Fabiana Castiglione, Vito Annese, Ambrogio Orlando

Research output: Contribution to journalArticle

Abstract

Background & Aims: Few data are available on effects of biologic therapies in patients more than 65 years old with inflammatory bowel disease (IBD). We evaluated the risk and benefits of therapy with tumor necrosis factor (TNF) inhibitors in these patients. Methods: We collected data from patients with IBD treated with infliximab (n = 2475) and adalimumab (n = 604) from 2000 to 2009 at 16 tertiary centers. Ninety-five patients (3%) were more than 65 years old (52 men; 37 with ulcerative colitis and 58 with Crohn's disease; 78 treated with infliximab and 17 with adalimumab). The control group comprised 190 patients 65 years old or younger who were treated with both biologics and 190 patients older than 65 years who were treated with other drugs. The primary end points were severe infection, cancer, or death. Results: Among patients more than 65 years old who received infliximab and adalimumab, 11% developed severe infections, 3% developed neoplasms, and 10% died. No variable was associated with severe infection or death. Among control patients more than 65 years old, 0.5% developed severe infections, 2% developed cancer, and 2% died. Among control patients less than 65 years old, 2.6% developed severe infections, none developed tumors, and 1% died. Conclusions: Patients older than 65 years treated with TNF inhibitors for IBD have a high rate of severe infections and mortality compared with younger patients or patients of the same age that did not receive these therapeutics. The effects of anti-TNF agents in older patients with IBD should be more thoroughly investigated, because these patients have higher mortality related to hospitalization than younger patients.

Original languageEnglish
Pages (from-to)30-35
Number of pages6
JournalClinical Gastroenterology and Hepatology
Volume9
Issue number1
DOIs
Publication statusPublished - Jan 2011

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Inflammatory Bowel Diseases
Tumor Necrosis Factor-alpha
Mortality
Infection
Therapeutics
Neoplasms
Biological Therapy
Biological Products
Ulcerative Colitis
Crohn Disease
Hospitalization

Keywords

  • Aging
  • Drug Complications
  • Inflammation
  • Side Effects

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Advanced Age Is an Independent Risk Factor for Severe Infections and Mortality in Patients Given Anti-Tumor Necrosis Factor Therapy for Inflammatory Bowel Disease. / Cottone, Mario; Kohn, Anna; Daperno, Marco; Armuzzi, Alessandro; Guidi, Luisa; D'Inca, Renata; Bossa, Fabrizio; Angelucci, Erika; Biancone, Livia; Gionchetti, Paolo; Ardizzone, Sandro; Papi, Claudio; Fries, Walter; Danese, Silvio; Riegler, Gabriele; Cappello, Maria; Castiglione, Fabiana; Annese, Vito; Orlando, Ambrogio.

In: Clinical Gastroenterology and Hepatology, Vol. 9, No. 1, 01.2011, p. 30-35.

Research output: Contribution to journalArticle

Cottone, M, Kohn, A, Daperno, M, Armuzzi, A, Guidi, L, D'Inca, R, Bossa, F, Angelucci, E, Biancone, L, Gionchetti, P, Ardizzone, S, Papi, C, Fries, W, Danese, S, Riegler, G, Cappello, M, Castiglione, F, Annese, V & Orlando, A 2011, 'Advanced Age Is an Independent Risk Factor for Severe Infections and Mortality in Patients Given Anti-Tumor Necrosis Factor Therapy for Inflammatory Bowel Disease', Clinical Gastroenterology and Hepatology, vol. 9, no. 1, pp. 30-35. https://doi.org/10.1016/j.cgh.2010.09.026
Cottone, Mario ; Kohn, Anna ; Daperno, Marco ; Armuzzi, Alessandro ; Guidi, Luisa ; D'Inca, Renata ; Bossa, Fabrizio ; Angelucci, Erika ; Biancone, Livia ; Gionchetti, Paolo ; Ardizzone, Sandro ; Papi, Claudio ; Fries, Walter ; Danese, Silvio ; Riegler, Gabriele ; Cappello, Maria ; Castiglione, Fabiana ; Annese, Vito ; Orlando, Ambrogio. / Advanced Age Is an Independent Risk Factor for Severe Infections and Mortality in Patients Given Anti-Tumor Necrosis Factor Therapy for Inflammatory Bowel Disease. In: Clinical Gastroenterology and Hepatology. 2011 ; Vol. 9, No. 1. pp. 30-35.
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T1 - Advanced Age Is an Independent Risk Factor for Severe Infections and Mortality in Patients Given Anti-Tumor Necrosis Factor Therapy for Inflammatory Bowel Disease

AU - Cottone, Mario

AU - Kohn, Anna

AU - Daperno, Marco

AU - Armuzzi, Alessandro

AU - Guidi, Luisa

AU - D'Inca, Renata

AU - Bossa, Fabrizio

AU - Angelucci, Erika

AU - Biancone, Livia

AU - Gionchetti, Paolo

AU - Ardizzone, Sandro

AU - Papi, Claudio

AU - Fries, Walter

AU - Danese, Silvio

AU - Riegler, Gabriele

AU - Cappello, Maria

AU - Castiglione, Fabiana

AU - Annese, Vito

AU - Orlando, Ambrogio

PY - 2011/1

Y1 - 2011/1

N2 - Background & Aims: Few data are available on effects of biologic therapies in patients more than 65 years old with inflammatory bowel disease (IBD). We evaluated the risk and benefits of therapy with tumor necrosis factor (TNF) inhibitors in these patients. Methods: We collected data from patients with IBD treated with infliximab (n = 2475) and adalimumab (n = 604) from 2000 to 2009 at 16 tertiary centers. Ninety-five patients (3%) were more than 65 years old (52 men; 37 with ulcerative colitis and 58 with Crohn's disease; 78 treated with infliximab and 17 with adalimumab). The control group comprised 190 patients 65 years old or younger who were treated with both biologics and 190 patients older than 65 years who were treated with other drugs. The primary end points were severe infection, cancer, or death. Results: Among patients more than 65 years old who received infliximab and adalimumab, 11% developed severe infections, 3% developed neoplasms, and 10% died. No variable was associated with severe infection or death. Among control patients more than 65 years old, 0.5% developed severe infections, 2% developed cancer, and 2% died. Among control patients less than 65 years old, 2.6% developed severe infections, none developed tumors, and 1% died. Conclusions: Patients older than 65 years treated with TNF inhibitors for IBD have a high rate of severe infections and mortality compared with younger patients or patients of the same age that did not receive these therapeutics. The effects of anti-TNF agents in older patients with IBD should be more thoroughly investigated, because these patients have higher mortality related to hospitalization than younger patients.

AB - Background & Aims: Few data are available on effects of biologic therapies in patients more than 65 years old with inflammatory bowel disease (IBD). We evaluated the risk and benefits of therapy with tumor necrosis factor (TNF) inhibitors in these patients. Methods: We collected data from patients with IBD treated with infliximab (n = 2475) and adalimumab (n = 604) from 2000 to 2009 at 16 tertiary centers. Ninety-five patients (3%) were more than 65 years old (52 men; 37 with ulcerative colitis and 58 with Crohn's disease; 78 treated with infliximab and 17 with adalimumab). The control group comprised 190 patients 65 years old or younger who were treated with both biologics and 190 patients older than 65 years who were treated with other drugs. The primary end points were severe infection, cancer, or death. Results: Among patients more than 65 years old who received infliximab and adalimumab, 11% developed severe infections, 3% developed neoplasms, and 10% died. No variable was associated with severe infection or death. Among control patients more than 65 years old, 0.5% developed severe infections, 2% developed cancer, and 2% died. Among control patients less than 65 years old, 2.6% developed severe infections, none developed tumors, and 1% died. Conclusions: Patients older than 65 years treated with TNF inhibitors for IBD have a high rate of severe infections and mortality compared with younger patients or patients of the same age that did not receive these therapeutics. The effects of anti-TNF agents in older patients with IBD should be more thoroughly investigated, because these patients have higher mortality related to hospitalization than younger patients.

KW - Aging

KW - Drug Complications

KW - Inflammation

KW - Side Effects

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