OLDER adults with inflammatory bowel disease (IBD) treated with advanced therapies (AT) may face a slightly increased risk of infection compared to those receiving non-immunosuppressive treatments, according to new research presented at Digestive Disease Week (DDW) 2024.
The study, which used data from Medicare Fee-For-Service claims between 2012-2019, examined the infection risk in patients aged ≥65 years who were treated with immunomodulators, biologics, or small molecule drugs, collectively known as ATs. The researchers aimed to understand whether the immunosuppressive nature of these therapies raised infection risks in older adults, whose treatment is complicated by factors such as comorbidities.
The study compared infection rates between 672 patients treated with ATs and 672 patients treated with mesalamine or 5-aminosalicylic acid (5ASA) drugs, which are not immunosuppressive. Approximately 60% of the cohort was 65–74 years of age, approximately 33% were 75-85 years and the remainder were ≥85 years. Most participants were female (64%) and White (91%). The most common comorbidities among the cohort members were hypertension (46%), hyperlipidaemia (35%), and diabetes (17%).
During the 1-year follow-up, 90 patients in the AT group developed infectious diseases, resulting in an infection rate of 14.5 per 100 person-years. Meanwhile, 84 patients in the 5ASA group developed infections, with a slightly lower infection rate of 13.5 per 100 person-years. After adjusting for factors such as age, comorbidities, and steroid use, the study found no statistically significant difference in infection risk between the two groups. The adjusted hazard ratio was 1.059 (95% CI: 0.786–1.427), indicating a non-significant increase in infection risk for those on ATs.
The study concluded that, while there is a marginally higher infection rate for older patients with IBD using advanced therapies, the risk is not significantly elevated compared to those on non-immunosuppressive treatments. The decision to use advanced therapies in older patients with IBD should consider both the potential benefits and the slightly increased infection risk.
Ada Enesco, EMJ
Reference
Daneshmand A et al. Initiation of immunomodulators or advanced therapies compared to 5ASA alone not linked to increased risk of serious infections in the Medicare IBD population. Abstract Sa1750. DDW2024, May 18-21, 2024.
