Safety and Efficacy of Vedolizumab Versus Tumor Necrosis Factor α Antagonists in an Elderly IBD Population: A Single Institution Retrospective Experience.

Abstract

BACKGROUND:

Vedolizumab is a monoclonal antibody used to treat inflammatory bowel disease (IBD). There is little known about the safety and comparative efficacy of this agent in the elderly population.

AIMS:

Here, we present data on the safety and comparative efficacy of vedolizumab versus tumor necrosis factor α antagonists (anti-TNF) in elderly patients with IBD.

METHODS:

This retrospective cohort study included IBD patients started on vedolizumab or anti-TNF at age 60 or older at a single tertiary IBD center. Safety was evaluated by assessing for the development of serious infection. The comparative needs for IBD-related surgery, IBD-related hospitalization, and drug discontinuation for any reason were obtained. Efficacy was assessed by comparing changes in endoscopic, histologic, and patient-report outcomes.

RESULTS:

212 cases were identified-108 patients treated with vedolizumab and 104 patients treated with anti-TNF. There were no significant differences between cohorts in serious infection, surgical intervention, or IBD-hospitalization-free survival (p = NS). Drug discontinuation survival was different between anti-TNF and vedolizumab (p = 0.02) with more patients remaining on vedolizumab at the time of last follow-up (51.9% vs. 25.9%). Endoscopic remission and response rates were higher in the vedolizumab versus anti-TNF group (65.7% vs. 45.2%, p = 0.02; 80.0% vs. 59.3%, p < 0.001).

CONCLUSIONS:

In a cohort of IBD patients over age 60, vedolizumab showed no statistically significant differences in infection, hospitalization, or surgical intervention-free survival as compared to anti-TNF. Vedolizumab was discontinued less frequently than anti-TNF. Patients on vedolizumab had higher rates of endoscopic remission and response.

• Authors: Baldeep S Pabla, C Alex Wiles, James C Slaughter, Elizabeth A Scoville, Robin L Dalal, Dawn B Beaulieu, David A Schwartz, Sara N Horst
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 67 Issue 7 Pg. 3129-3137 (07 2022) ISSN: 1573-2568 [Electronic] United States
• PMID: 34268660 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Antibodies, Monoclonal, Humanized
• Gastrointestinal Agents
• Tumor Necrosis Factor Inhibitors
• Tumor Necrosis Factor-alpha
• vedolizumab

Topics

• Aged
• Antibodies, Monoclonal, Humanized
• Colitis, Ulcerative (drug therapy)
• Gastrointestinal Agents (adverse effects)
• Humans
• Inflammatory Bowel Diseases (chemically induced, drug therapy)
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Tumor Necrosis Factor Inhibitors
• Tumor Necrosis Factor-alpha