Original article–alimentary tractAdvanced Age Is an Independent Risk Factor for Severe Infections and Mortality in Patients Given Anti–Tumor Necrosis Factor Therapy for Inflammatory Bowel Disease
Section snippets
Patients and Methods
Sixteen Italian referral centers, which prospectively collected data on the treatment of IBD patients with biological agents since the introduction of these agents on the market, participated in the study.
The following data were collected: age of patients, type and location of inflammatory bowel disease, indication for treatment, comorbidities, concomitant treatment, disease activity scores, side effects, maintenance therapy, time elapsed from start of biologics, surgery after biological
Results
Ninenty-five patients out of 3079 (3%) were over 65 years of age. Demographic characteristics are reported in Table 1. Thirty-six had UC, and 58 had CD. Seventy-eight patients were treated with infliximab (42 CD and 36 UC) and 17 with adalimumab (16 CD and 1 UC). The mean length of follow-up from the first biological treatment was 26 months (range, 3–82). At the start of biological treatment the median CDAI was 211 (range, 149–439) in CD patients, while 22 UC patients had moderate disease and
Discussion
Following the enactment of the Social Security Act in the United States in 1965, most social and medical studies began defining those 65 and older as “elderly.” To the best of our knowledge, no study has been published on the outcomes of elderly IBD patients treated with biologics. This multicenter study shows that anti-TNF therapy in IBD is equally effective in elderly as in adult patients in both diseases, but it is hampered by the high rate of side effects. Severe infections occurred in 11%
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Conflicts of Interest The authors disclose the following: Dr Mario Cottone has received funds for scholarships and support for participation in international congresses from Abbott, as well as funds for improving services in hospitals and participation in congresses from Schering–Plough. He reports participation in continuing medical education events sponsored by Giuliani, Chiesi, and Sofar. Dr Ambrogio Orlando has received fees for educational courses, satellite symposia, and support for participation in international congresses from Abbott. He reports participation in continuing medical education events sponsored by Giuliani, Chiesi, and Sofar. Dr Maria Cappello reports participation in continuing medical education events sponsored by Giuliani, Schering–Plough, and Abbott. Dr Paolo Gionchetti is on the advisory board of Abbott for 2010. He has received support for participation in international congresses. He reports participation in continuing medical education events sponsored by Ferring, Giuliani, Schering–Plough, and Abbott. Dr Vito Annese reports participation in continuing medical education events sponsored by Schering–Plough and Abbott. Dr Anna Kohn reports participation in continuing medical education events sponsored by Giuliani, Schering–Plough, and Abbott. Dr Silvio Danese has received consulting fees from Schering–Plough, Abbott Laboratories, AstraZeneca, UCB Pharma, Actelion, Danone, and Ferring. He reports participation in continuing medical education events sponsored by Abbott Laboratories, Ferring, UCB Pharma, Schering–Plough, Giuliani Pharma, and Chiesi. Dr Walter Fries reports participation in continuing medical education events sponsored by Schering–Plough and Abbott. Dr Alessandro Armuzzi reports participation in continuing medical education events sponsored by Schering–Plough and Abbott. Dr Gabriele Riegler reports participation in continuing medical education events sponsored by Schering–Plough and Abbott. Dr Fabiana Castiglione reports participation in continuing medical education events sponsored by Schering–Plough and Abbott. Dr Sandro Ardizzone reports participation in continuing medical education events sponsored by Schering–Plough and Abbott. Dr Livia Biancone reports participation in continuing medical education events sponsored by Schering–Plough and Abbott. Dr Renata d'Inca reports participation in continuing medical education events sponsored by Schering–Plough and Abbott. Dr Fabrizio Bossa reports participation in continuing medical education events sponsored by Schering–Plough and Abbott. Dr Luisa Guidi reports participation in continuing medical education events sponsored by Schering–Plough and Abbott. Dr Marco Daperno reports participation in continuing medical education events sponsored by Schering–Plough and Abbott.