The Efficacy and Safety of Anti-TNF Therapy in Older Patients With Inflammatory Bowel Disease: A Tale of 2 Cities
Bibliographic record
Abstract
Introduction: The role of anti-TNF agents in the induction and maintenance of remission for moderate-severe inflammatory bowel disease (IBD) has been well-established; however, data on their use in older patients are conflicting. Our aim was to evaluate the efficacy and safety of anti-TNF agents in older IBD patients compared with younger patients and with older patients on immunomodulator (IM) therapy. Methods: We conducted a retrospective nested case-control study of IBD patients seen at Boston Medical Center (Boston, USA) and Pennine Acute Hospitals (Manchester, UK) from 9/2006-8/2016. A total of 50 IBD patients who initiated therapy after age ≥60 (age≥60+TNF) were matched to two groups of controls: 101 patients < 60 years on anti-TNF (age < 60+TNF) and 50 patients ≥ 60 years on IM therapy alone (age≥60+IM). Multivariable logistical regression models were used to determine clinical response after ≥6 months of therapy and the odds of serious adverse events. Results: Cases (age≥60+TNF) had significantly lower clinical response compared to controls: age 60+TNF (50% vs. 72.7%, p=0.01) and age≥60+IM (50% vs. 88%, p < 0.001). After adjusting for age, Charlson Comorbidity Index, duration on therapy, IBD-related surgery and concurrent IM use, however, cases had similar rates of response compared with youngers controls age < 60+TNF. In adjusted models (for Montreal classification, duration on therapy and prior surgery), cases had significantly lower rates of response compared with controls on IM therapy age≥60+IM (OR=0.28 (95% CI 0.09-0.9, p=0.03). The duration of anti-TNF therapy was similar for cases vs younger controls (age < 60+TNF: 30 vs 43 months, p=0.06) but significantly shorter for IM controls (age≥60+IM: 30 vs 70 months, p < 0.0001). In adjusted models, there was no significant difference in risk for serious adverse events compared to controls: age < 60+TNF (OR=2.3, 95% CI 0.04-11; p=0.3) and age≥60+IM (OR=1.95, 95% CI 0.6-6.6; p=0.3). Conclusion: Our results demonstrate similar efficacy of anti-TNF therapy in adults ≥60 compared with younger controls; however, we did observe decreased efficacy compared with IM therapy. We did not observe a difference in serious adverse events. More data on efficacy and safety of anti-TNF therapy in older patients are needed to confirm these findings and offer further mechanistic insights, enabling clinicians to make personalized, but evidence-based decisions in the optimal management of older patients with IBD.
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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 | 0.011 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".