Systematic reviews and meta-analysesSafety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis
Section snippets
Literature Search
We performed a systematic electronic search of the MEDLINE and Embase databases to identify eligible studies examining safety of biologic therapy in older patients with IMD. Our search encompassed articles published from the inception of MEDLINE and Embase up to June 2018. We did not apply any language restrictions but required at least the abstract to be available in English. Our search combined 4 different phrase groups by using the Boolean operator AND. The first phrase included terms to
Literature Search
Our initial literature search identified 756 relevant studies on MEDLINE or Embase from inception to June 2018. Upon review of title and abstract, 33 articles were selected for full-text review (Figure 1). Among these, 19 additional studies were excluded. Three studies had no detailed data available regarding safety outcomes,13, 14, 15 2 studies were not accessible in full-text,16, 17 and 1 study was excluded because it included fewer than 10 patients.18 Thirteen studies were excluded because
Discussion
The therapeutic armamentarium for chronic IMDs has considerably expanded with the introduction of more effective biologic therapies leading to improved patient outcomes. However, safety concerns, particularly risk of infection and malignancy, remain. A population that is particularly vulnerable to those risks yet underrepresented in cohorts and clinical trials, is the older patient. In this systematic review and meta-analysis, we quantify the risk of infection, malignancy, and mortality in
References (46)
- et al.
Age as a risk factor
Med Clin North Am
(2012) - et al.
Risks and benefits of infliximab for the treatment of Crohn's disease
Clin Gastroenterol Hepatol
(2006) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Increased hospitalizations in elderly with inflammatory bowel disease on anti-tumor necrosis factor therapy but not increased infections: a community practice experience
J Crohns Colitis
(2014) - et al.
Advanced age is an independent risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease
Clin Gastroenterol Hepatol
(2011) - et al.
Risk factors for opportunistic infections in patients with inflammatory bowel disease
Gastroenterology
(2008) National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States
(2011)US Cancer Statistics: 1999 - 2009 Incidence and Mortality Web-Based Report
(2013)- et al.
Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications
Br J Clin Pharmacol
(2004) - et al.
Second-line antirheumatic drugs in the elderly with rheumatoid arthritis: a post hoc analysis of three controlled trials
Pharmacotherapy
(1990)
Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease
Aliment Pharmacol Ther
Older age is associated with higher rate of discontinuation of anti-TNF therapy in patients with inflammatory bowel disease
Inflamm Bowel Dis
[Anti-TNF α agents in elderly patients with rheumatoid arthritis: a study of a group of 105 over sixty five years old patients]
Reumatismo
Metaprop: a Stata command to perform meta-analysis of binomial data
Arch Public Health
Response of elderly patients with rheumatoid arthritis to methotrexate or TNF inhibitors compared with younger patients
Rheumatology (Oxford)
Influence of age on the outcome of antitumour necrosis factor alpha therapy in rheumatoid arthritis
Ann Rheum Dis
Efficacy and safety of ustekinumab treatment in elderly patients with psoriasis
J Dermatol
Biologic and Conventional Systemic Therapies Show Similar Safety and Efficacy in Elderly and Adult Patients With Moderate to Severe Psoriasis
J Drugs Dermatol
The association between elderly rheumatoid arthritis patients using biologics and adverse events: retrospective cohort study
Ann Rheum Dis
Fatal infections in older patients with inflammatory bowel disease on anti-tumor necrosis factor therapy
Intest Res
Biologic treatments for elderly patients with psoriasis
J Dermatol
Efficacy and safety of subcutaneous anti-tumor necrosis factor-alpha agents, etanercept and adalimumab, in elderly patients affected by psoriasis and psoriatic arthritis: an observational long-term study
Dermatology
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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e108. Learning Objective–Upon completion of this activity, successful learners will be able to define the diagnosis, natural history, and treatment of IBD in older individuals.
Conflicts of interest This author discloses the following: Ashwin N. Ananthakrishnan has served on advisory boards for Abbvie, Takeda, and Merck. He is supported by research funding from the Crohn’s and Colitis Foundation, National Institutes of Health, Chleck Family Foundation, and Pfizer. The other author discloses no conflicts.