TNF inhibitors less effective for patients who developed IBD later in life

In a new retrospective study conducted in Japan by Takahiro Amano and team,  it was found that treatment with Tumor necrosis factor (TNF) inhibitors were less effective for patients who developed inflammatory bowel disease (IBD) later in life. Besides being less successful there were safety issues. Tumor necrosis factor (TNF) inhibitors were less effective for patients who developed inflammatory bowel disease (IBD) later in life, a retrospective study in Japan found.

The findings of this study were published in Nature Scientific reports.

The results of individuals with elderly-onset inflammatory bowel disease who were treated with anti-TNF remain unknown. The current study looked at the effectiveness and safety of anti-TNF medication in bio-naive EO-IBD patients.

Elderly patients were identified as those 60 years and older for this study, and they were further split into those with EO (Elderly-EO) and those with non-elderly onset (Elderly-NEO). In this multicenter observational trial, 432 bio-naive individuals were included, including 55 with Elderly-EO (12.7%), 25 with Elderly-NEO (5.8%), and 352 under the age of 60 (Non-elderly, 81.5% ).

The results of this study stated as follow:

Clinical and steroid-free remission rates were considerably lower in Elderly-EO than in Non-elderly (37.7% and 60.8% ; P = 0.001, and 35.9% and 57.8% ; P = 0.003, respectively) after 52 weeks of anti-TNF therapy, but equivalent in Elderly-NEO and Non-elderly.

After 52 weeks of anti-TNF therapy, multivariate analysis indicated that elderly onset was a significant predictor for both clinical remission (OR, 0.49, 95% CI 0.25–0.96) and steroid-free remission (OR, 0.51, 95% CI 0.26–0.99).

The rate of cumulative severe adverse events was considerably greater in the Elderly-EO group than in the Non-elderly group (P = 0.007), but equivalent in the Elderly-NEO and Non-elderly groups.

In conclusion, this study discovered that individuals with elderly-onset IBD who had Crohn's disease, IBD for less than a year, and no concomitant corticosteroid usage were more likely to benefit from TNF inhibitor treatment in the long run. The authors noted that the data had significant limitations, including potential selection bias for individuals on TNF blockers and a lack of reliable information on comorbidities. They also said that several analyses were hampered by the small sample size of individuals with elderly-onset illness.

Reference:

Amano, T., Shinzaki, S., Asakura, A., Tashiro, T., Tani, M., Otake, Y., Yoshihara, T., Iwatani, S., Yamada, T., Sakakibara, Y., Osugi, N., Ishii, S., Egawa, S., Araki, M., Elderly onset age is associated with low efficacy of first anti-tumor necrosis factor treatment in patients with inflammatory bowel disease. In Scientific Reports (Vol. 12, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1038/s41598-022-09455-8

Keywords: inflammatory bowel disease, Crohn's, elderly, tumor necrosis factor, steroid, gastroenterology, inflammation, Nature, scientific reports,