Résumé
BackgroundAnti-tumour necrosis factor (anti-TNF) agents are associated with increased infection risk among elderly inflammatory bowel disease (IBD) patients and thus alternative biologics may be preferable. However, there is little data on the safety and efficacy of novel biologics compared to anti-TNF agents in the elderly.AimsTo compare the safety and effectiveness of ustekinumab and anti-TNF agents in elderly Crohn’s disease (CD) patients.MethodsPatients ≥60 years old who commenced ustekinumab or an anti-TNF agent for CD were included. The primary outcome was time to occurrence of any infection. Secondary outcomes included serious infections, defined as requiring hospitalisation. Efficacy was assessed by treatment persistence and clinical response rates. We appropriately adjusted for confounders using inverse predicted probability of treatment weighting (IPTW) and performed a logistic regression analysis to assess factors associated with infections and treatment persistence.ResultsEighty-three patients commencing ustekinumab and 124 commencing anti-TNF therapy were included. In a propensity adjusted cohort, the time to occurrence of infection was comparable between ustekinumab and anti-TNF agents (figure 1). There was no difference in the rate of serious infections. Treatment persistence was comparable between ustekinumab and anti-TNF agents. There was a significant reduction in HBI at 6 and 12 months compared to baseline in both groups. None of the clinical variables were associated with infection risk. Cox regression analysis showed no overall difference in treatment discontinuation free and serious infection free survival by 12 months.ConclusionsWe observed comparable safety and effectiveness for ustekinumab and anti-TNF agents in treating elderly CD patients.Abstract P54 Figure 1Inverse probability treatment weighted Kaplan-Meier curve of overall infection free survival with ustekinumab and anti-TNF (crosses represent censors)