PWE-068 Adverse events in elderly inflammatory bowel disease patients managed with anti-TNF therapy

Introduction In a population with an increasing life expectancy, a sizable proportion of inflammatory bowel disease (IBD) patients are elderly. The management of IBD often requires immunosuppressing anti-tumour necrosis factor (anti-TNF) drugs which add to the immunosuppressive effects of ageing. Evidence for the safety of anti-TNF therapy in the elderly is scarce. Our objective was to assess the safety of anti-TNF therapy in the elderly considering their co-morbidities and immunomodulators (IM). Methods Retrospective single centre study The IBD database of a large teaching hospital was interrogated for patients aged u003e65 years who had been prescribed infliximab or adalimumab. Patient electronic records were reviewed along with general practice prescribing records. Data was collected on co-morbidities, IM use, hospitalisations, significant adverse events (any reaction requiring discontinuation of the anti-TNF), and antibiotic prescriptions. Charlson Co-Morbidity index (CCI) was calculated. Results 80 patients (51 female) aged u003e65 received either infliximab (n=50) or adalimumab (n=30). Crohn’s disease (n=70) was more common and 34 patients were on a concomitant IM. The median duration of follow-up (FU) was 4 years and the median duration of therapy was 14 months. There were 5 deaths during FU, 4 after cessation of anti-TNF (2 pneumonias, 1 chronic obstructive pulmonary disease, 1 malignancy) and 1 patient was still on an anti-TNF (Crohn’s related malnutrition). Seven patients developed cancer, 5 still on an anti-TNF and the other two were one and two years post-cessation of anti-TNF. Of the 5 patients who developed cancers on an anti-TNF, all 5 restarted their anti-TNF after treatment of the cancer. Eight patients (10.5%) required hospitalisation due to what was felt to be an anti-TNF related event (7 infective, 1 allergic reaction). Patients on an IM had a 15.4% chance of anti-TNF related hospitalisation vs 4.4% in those not on a concomitant IM (p=0.09). Concomitant IM use had no statistical impact on the risk of developing a cancer (9.1% on an IM vs 6.5% not on an IM, p=0.49). Of those that required antibiotics, IM use did not seem to increase this risk (p=0.43). Thirty one percent of those that stopped their anti-TNF (n=50) did so because of an adverse event. When CCI=0 was compared with a CCI u003e0, they were no more likely to still be on an anti-TNF after 12 months. Conclusions In this series, we were unable to demonstrate a relationship between co-morbidities and tolerance of anti-TNF therapy. There was, although not reaching statistical significance, a relationship between concomitant IMs and risk of hospitalisation due potential anti-TNF related events. Elderly patients are more likely to stop anti-TNFs than the younger populations used in larger trials. Concomitant IMs must be carefully considered to reduce the risk of adverse events.