Background: Inflammatory bowel disease (IBD) presents unique challenges in elderly patients due to comorbidities and treatment-related risks.
Objectives: This study evaluates ustekinumab (UST) and vedolizumab (VDZ) efficacy and safety in elderly Crohn's disease (CD) patients.
Design: A retrospective cohort study at a tertiary medical center.
Methods: CD patients aged ⩾60 years (elderly) treated with UST, compared to non-elderly (<60 years) patients treated with UST and elderly patients treated with VDZ. Clinical response was evaluated using the Harvey-Bradshaw index (HBI) and clinical biomarkers, alongside monitoring steroid use, hospitalization rates, treatment persistence, and surgical interventions.
Results: The study included 166 CD patients: 32 elderly and 65 non-elderly patients treated with UST, and 69 elderly patients treated with VDZ. The mean duration of follow-up was 10.8 ± 2.8 months in the non-elderly group, 9.97 ± 3.28 months in the elderly UST group, and 10.0 ± 3.29 months in the VDZ group. Elderly UST patients were more likely to receive corticosteroids at initiation than non-elderly UST patients (44% vs 14%, p = 0.001). At 12 months, clinical response rates did not significantly differ between elderly and non-elderly UST groups, respectively (48% vs 40%, p = 0.5). However, elderly UST patients exhibited higher hospitalization rates over time compared to non-elderly UST patients (6-month: 19% vs 6.2%, p = 0.077; 12-month: 19% vs 4.6%, p = 0.055; log-rank p = 0.004). No significant differences were observed in clinical response and remission rates between elderly UST and elderly VDZ patients at 6 and 12 months. At 6 months, a higher hospitalization rate was observed in the UST group (19% vs 4.3% p = 0.027), but this difference did not persist over time.
Conclusion: UST and VDZ are effective and safe treatments for elderly CD patients, despite higher hospitalization rates compared to non-elderly patients, likely due to age-related complications.
Keywords: Crohn’s disease; elderly; ustekinumab; vedolizumab.
Short term effectiveness and safety of ustekinumab and vedolizumab in elderly and non-elderly patients with Crohn’s disease – a comparative study In older adults with Crohn’s disease, managing treatment can be complex due to age-related health issues. This study examined how two medications, ustekinumab (UST) and vedolizumab (VDZ), perform in patients aged 60 and older. Researchers compared UST’s effectiveness in elderly patients to its use in younger adults and VDZ’s performance in the elderly. They found that while elderly patients starting UST were more likely to need corticosteroids initially, their 12-month clinical response rates were similar to younger patients. However, elderly UST users had higher hospitalization rates over time. Results also showed no significant difference in outcomes between elderly patients using UST versus VDZ, despite initial concerns about hospitalizations. Overall, both UST and VDZ appear safe and effective for elderly Crohn’s disease patients, although hospitalization risks remain higher compared to younger adults, reflecting age-related health challenges.
© The Author(s), 2024.