Safety and effectiveness of ustekinumab in elderly Crohn’s disease patients

作者：Joseph Fiske, Eleanor Liu, Jimmy K. Limdi, Thomas Edward Conley, Tristan Townsend, M.R.Q. Davies, Robert Brockwell, Daniyal Baig, Sherif Abdelbadiee, Anastasia Uney, Angela Liaros, Waqas Gaba, Philip J Smith, Paul K. Flanagan, Sreedhar Subramanian · 发表于：European Journal of Gastroenterology & Hepatology · 年份：2022 · DOI：10.1097/meg.0000000000002436 · 被引用次数：14 · 研究领域：Inflammatory Bowel Disease、Rheumatoid Arthritis Research and Therapies、Autoimmune and Inflammatory Disorders

OBJECTIVE: Anti-tumour necrosis factor (TNF) agents are associated with increased infection risk among elderly IBD patients, but little is known about non anti-TNF biologics in this cohort. We examined the safety and effectiveness of ustekinumab in elderly Crohn's patients. METHODS: This retrospective multi-centre cohort study included Crohn's patients ≥60-years old who commenced ustekinumab. We recorded Harvey-Bradshaw index (HBI), concomitant steroid therapy, treatment persistence and new infections or malignancies. Primary outcome was serious infections requiring hospitalisation. RESULTS: Seventy patients were included, with median age of 68 years. 43 (61.4%) had prior anti-TNF exposure, and 15 (21.4%) vedolizumab. Median treatment duration was 12 months, totalling 84 patient-years. Nine serious infections were reported, incidence 106.7/1000 patient-years. Systemic steroids were associated with increased risk of serious infections [odds ratio (OR) 7.83, 95% confidence interval (CI): 1.44-44.32, P = 0.02]. There were 27 "non-serious" infections; 321.4/1000 patient-years. Charlson co-morbidity index (OR 1.49, 95% CI: 1.05-2.12, P = 0.03) and steroid exposure (OR 44.10, 95% CI: 1.75-1112.10, P = 0.02) increased non-serious infection risk (P < 0.05). Mean HBI improved from 8.13 to 4.64 at 6 months and 4.10 at last follow up (P < 0.0001). 12-month treatment persistence was 55.7% (N = 39); 34 (48.6%) were steroid-free. CONCLUSION: Ustekinumab was safe and effective in a cohort o...