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Vedolizumab Associated With Lower Infection Risk Among Older Patients With IBD
A retrospective cohort study of patients 65 years and older initiating treatment for inflammatory bowel disease (IBD) revealed that patients treated with vedolizumab had a lower risk of infection-related hospitalization compared with those who began treatment with anti-tumor necrosis factor (TNF) therapies.
Researchers at Massachusetts General Hospital and the University of North Carolina noted in their report, “Despite the increased numbers of older adults with inflammatory bowel diseases (IBDs), there are few studies regarding the safety and effectiveness of IBD treatments in older adults.”
To help to rectify this gap in knowledge, the investigators used an active comparator, new-user design to analyze Medicare claims for adults aged 65 years and older with IBD who began treatment with anti–TNF-α agents and or vedolizumab during the period 2014 to 2017. “The primary safety outcome was infection-related hospitalization (excluding intra-abdominal and perianal abscesses),” the authors stated.
Coprimary outcomes included hospitalizations for IBD-related complications, IBD-related surgery, and new corticosteroid use 60 days or more after initiating treatment with a biologic.
The researchers identified 1152 new users of anti–TNF-α therapies and 480 new users of vedolizumab. The median age of these patients was 71 years in both cohorts; 11% were aged 80 years or older. Patients with Crohn’s disease comprised 54% of the cohort that began treatment with anti-TNFs and 57% of the group that initiated vedolizumab.
“There was no significant difference in demographics, health care utilization, or frailty in both cohorts,” the authors wrote. “More than half of both cohorts had a Charlson comorbidity index of 2 or higher. Vedolizumab users had a decreased risk of infection-related hospitalization (adjusted hazard ratio, 0.47; 95% confidence interval, 0.25–0.86). There was no significant difference in the outcomes approximating effectiveness.”
--Rebecca Mashaw
REFERENCE:
Kochar B, Pate V, Kappelman MD, et al. Vedolizumab is associated with a lower risk of serious infections than anti-tumor necrosis factor agents in older adults. Clin Gastroenterol Hepatol. 2022;20(6): P1299-1305.E5. DOI: https://doi.org/10.1016/j.cgh.2021.08.047
