Comorbidities Linked to Immunomodulator use in IBD
Physicians should be careful when prescribing immunomodulator therapy to patients with inflammatory bowel disease who have higher comorbid status regardless of their age, according to research published in Inflammatory Bowel Diseases.
Viraj C . Kariyawasam, MRCP, FRACP, of the department of gastroenterology at Concord General Repatriation Hospital in Australia, and colleagues wrote that immunomodulators are often avoided in elderly-onset IBD despite evidence that they might be beneficial early in the course of the disease.
“Their use in the elderly is tentative due to higher risks of adverse effects and opportunistic infections,” they wrote. “Physicians may therefore avoid [immunomodulator] use in older patients with IBD.”
Researchers analyzed data from the Sydney IBD cohort comprising patients diagnosed with IBD from 1970 to 2009. They classified patients as either “elderly-onset” (60 years or older; n = 255) or “young-onset” (16 to 40 years; n = 1,244) and compared the use of immunomodulators between the two groups.
Investigators found that cumulative probability of immunomodulator exposure at five years post-diagnosis was significantly less in elderly-onset patients compared with young-onset patients in both Crohn’s disease (20% vs. 33.4%; P = .0002) and ulcerative colitis (7.8% vs. 13.4%; P = .0007). Meanwhile, age at diagnosis was not associated with the time to immunomodulator introduction.
Patients with higher comorbid status, based on the Charlson Comorbidity Index, experienced a delayed introduction to immunomodulators in both CD (HR = 0.863; 95% CI, 0.787-0.946) and UC (HR = 0.807; 95% CI, 0.711-0.917). Earlier immunomodulator use was associated with a reduced need for abdominal and perianal surgery in patients with CD (HR = 0.177; 95% CI, 0.089-0.351).
Kariyawasam and colleagues wrote that more research is needed to determine the effects of comorbidities on the efficacy and safety of immunomodulators.
“[Immunomodulators] should be prescribed with care in patients with high comorbid status, regardless of their age or severity of disease,” they wrote. “Elderly patients who are fit and healthy should be considered for earlier use of [immunomodulators] in their disease course for maximal quality of life and to reduce risk of surgery.” – by Alex Young
Disclosures: Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures.