P063 SAFETY OF BIOLOGIC THERAPY IN OLDER PATIENTS WITH IMMUNE-MEDIATED DISEASES: A SYSTEMATIC REVIEW AND META-ANALYSIS. (7th February 2019)

• Record Type: Journal Article
• Authors: Borren, Nynke Z; Ananthakrishnan, Ashwin
• Is Part Of: Inflammatory bowel diseases. Volume 25(2019)Supplement 1
• Page Start: S30
• Page End: S30
• Publication Date: 2019-02-07
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izy393.069
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Introduction: Lifelong immunosuppression is a cornerstone of management of immune-mediated inflammatory diseases (IMD). Older patients represent an increasingly large number of patients with these diseases but are particularly vulnerable to safety risks with therapy, particularly that of infection and malignancy. We performed this systematic review and meta-analysis to calculate the pooled safety of biologic therapy in older patients with IMD when compared to similar patients on non-biologic therapies or younger biologic users. Methods: We systematically searched PubMed/Medline and Embase to identify eligible studies examining safety of biologic therapy in older patients with IMD. To be eligible for inclusion, studies need to provide information on patients with an IMD >60 years initiating biologic therapy and a control population consisting of either younger biologic users or older non-biologic users. Information of on overall pooled rates of infections and malignancy were extracted. A DerSimonian and Laird random effects model was used to calculate pooled odds ratios and 95% confidence intervals. Results: Our meta-analysis included 14 unique studies that comprised 4, 719 older biologic users, 13, 305 young biologic users and 3, 961 older control non-biologic users. The pooled prevalence of infections in older and younger biologic users was 13% and 6% respectively, yielding a pooled random effects odds ratio of 2.28 (95% CI 1.57 – 3.31) (Figure 1). Older biologic users were three-times as likely to develop pneumonia as younger biologic users (OR 3.09, 95% CI 1.02 – 9.39). Older age was associated with a significant increase in risk of malignancy (OR 3.03, 95% CI 1.98 – 4.62) (Figure 2) and mortality (OR 6.35, 95% CI 2.29 – 17.64) compared to younger patients. Stratifying by type of IMD, the excess risk of infection in older compared to younger biologic users was higher in those with IBD (OR 3.48, 95% CI 1.97 – 6.14) than in RA (OR 1.87, 95% CI 1.19 – 2.96) (p=0.09). However, the excess malignancy risk was similar in IBD (OR 3.47) and RA (OR 2.66) (p=0.60). Older biologic users were of 3-fold increased infection risk compared to non-biologic users (OR 3.60, 95% CI 1.62 – 8.01) but had similar rates of malignancy (0.54, 95% CI 0.28 - 1.05) and death (OR 1.52, 95% CI 0.44 – 5.28) when compared to older non-biologic users. Conclusion: Older biologic users had an increased risk of infections when compared to both younger biologic users and older non-biologic users with an IMD. There is an important need for large prospective cohorts to examine safety of biologic therapy in older patients with immune-mediated diseases. Figure 1. Forest plot of pooled infection risk among older patients with an IMD on biologic therapy compared to younger biologic users Figure 2. Forest plot of pooled malignancy risk among older patients with an IMD on biologic therapy compared to younger biologic users.