P336 Safety of anti-TNF treatment in older IBD patients: a systematic review and meta-analysis
Notice bibliographique
Résumé
Background: Anti-tumour necrosis factor (Anti-TNF) therapy is effective for both inducing and maintaining remission in IBD patients. Recent meta-analyses have demonstrated their safety in the general IBD population. However, little is reported about the safety of these drugs in elderly patients. Therefore, we aimed to investigate the safety of management of IBD in elderly patients using anti-TNF treatment by systematic review and meta-analysis of available data. Methods: A literature search was conducted for papers and conference proceedings through November 2016 regarding elderly IBD patients and anti-TNF therapy. All studies were appraised using the adapted Newcastle-Ottawa Scale (NOS), which contains 9 criteria for cohort studies and is adapted to 6 criteria for case series and case reports. Three reviewers independently extracted data on anti TNF-exposed older and younger patients, with number of serious infections, dead during follow-up and cessation of therapy due to adverse events as outcomes of interest. Poisson regression was used to compare the occurrence of outcomes of interest per patient year follow up between older and younger IBD patients. Results: From 454 found titles, four papers and 5 conference abstracts were included, totalling 1276 patients: 470 older and 806 younger patients. Data on combined steroid use was provided in 2 papers, data on IM combo-therapy in 5 papers. Papers used either 60 years or 65 years as cut off. The rate ratio for serious infections was similar between older and younger IBD patients (2.1, p=0.084) and was not influenced by IM use (rate ratio 2.8, p=0.054). However, when steroid use was added to the model, the rate ratio for serious infections was 2.35 (p<0.001, 95% CI 2.3–2.4 and use of steroid increased the risk (p<0.001). Risk of death did not significantly differ between older and younger patients during follow (risk ratio 10.4, p=0.19) and was not affected by use of IM (p=0.5). When use of steroids was added to the model, there was a trend towards an increased risk of death in older IBD patients during anti-TNF exposure (p=0.06, ratio 3.3, 95% CI 0.94–11.8) Older patients were 3.1 x more likely to stop anti-TNF therapy due to AE (p=0.008, 95% CI 1.34–7.4) compared to younger patients, and this was not influenced by use of IM. Too few data were available on steroid use. Conclusions: Although anti-TNF therapy is more often discontinued in older IBD patients due to adverse events, the use of anti-TNF was only associated with an increased risk for serious infections when combined with steroids. More data on safety of anti-TNF in elderly are needed, with special attention to indices of physical, frailty and mental and social impairment. This would enable a more personalised assessment of risk.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,036 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,015 | 0,036 |
| Bibliométrie | 0,006 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».