P336 Safety of anti-TNF treatment in older IBD patients: a systematic review and meta-analysis
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.036 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.036 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".