Therapy in elderly IBD patients

被引:0
|
作者
Castiglione, Fabiana [1 ]
Imperatore, Nicola [1 ]
Zingone, Fabiana [2 ]
D'Inca, Renata [2 ]
机构
[1] Univ Naples Federico II, Sch Med, Dept Clin Med & Surg, Gastroenterol Unit, Naples, Italy
[2] Univ Hosp Padua, Dept Surg Oncol & Gastroenterol, Via Giustiniani 2, I-35127 Padua, Italy
来源
MINERVA GASTROENTEROLOGY | 2024年 / 70卷 / 01期
关键词
Inflammatory bowel diseases; Aged; Biological products; Safety; INFLAMMATORY-BOWEL-DISEASE; DRUG-TREATMENT PRACTICES; ANTI-TNF THERAPY; RISK-FACTORS; OLDER AGE; EFFICACY; SAFETY; THIOPURINES; VEDOLIZUMAB; PREVALENCE;
D O I
暂无
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
INTRODUCTION: Appropriate treatment is critical in elderly inflammatory bowel disease (IBD) subjects since they are at higher risk of complications such as infections, malignancies and mortality. EVIDENCE ACQUISITION: We conducted an extensive PubMed search for guidelines, systematic reviews and primary studies to perform a critical analysis of the existing literature on the efficacy and safety of conventional and biological therapies for elderly IBD patients. EVIDENCE SYNTHESIS: Due to the exclusion of elderly population from clinical trials, most evidences comes from real-life studies. While aminosalicylates remain a cornerstone treatment of elderly patients with ulcerative colitis (UC), for their effectiveness and safety, their use in Crohn's disease (CD) should not be further supported. Corticosteroid use should be limited for the induction of remission, while as maintenance treatment it should be avoided, due to the low safety profile. Although as efficacious as in the younger population, immunosuppressant use has been associated with higher risk of infective/malignant issues and further use should be carefully evaluated. Biologics have demonstrated high effectiveness in the elderly. However, due to increased morbidity and mortality described in elderly subjects treated with anti-TNF alpha agents, vedolizumab and ustekinumab should be favoured over anti-TNF alpha agents. CONCLUSIONS: Treatment of elderly IBD patients remains challenging, since comorbidities and the risk of adverse events can complicate the effectiveness and safety of therapy. Close monitoring of such patients in a multidisciplinary team is advocated to reduce the risk of infections and optimize the treatment, choosing a suitable agent.
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页码:89 / 97
页数:9
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