Efficacy and safety of biologic agents on elderly patients with ulcerative colitis: A retrospective analysis

ABSTRACT

Introduction: Patients greater than 65 years old (yo) represent up to 30% of all Ulcerative colitis (UC) patients. A few studies in this population have shown poor outcomes with higher rates of infection, neoplasm, hospitalization, and mortality. However, no robust data exist on the use of biologics in the elderly population with UC. We present a retrospective analysis from 2010 to 2020 comparing outcomes such as mortality, adverse events, hospitalizations, and remission of moderate to severe UC patients 65 yo or more (≥) to those less than (<) 65 yo prescribed biologics. Methods: Data was gathered retrospectively from January 2010 to December 2020. Cohorts consisted of patients ≥18 yo with UC and no other co-existing autoimmune disease who were prescribed, biologic agents. Patient demographics were summarized as mean or proportions (%). Outcomes of interest were compared between groups according to age cutoff (≥65 yo vs , 65 yo) with the use of Pearson's chi-square or Fisher's exact test as appropriate. Multivariate analysis was conducted using logistic regression to identify independent variables associated with any of the outcomes of interest in both age groups. Results: 133 patients were included. The patient's baseline demographic characteristics were not found to be statistically significant (Table). Composite infection (18% vs 9%), skin adverse events (37% vs 32%), neoplasm (19% vs 2%), and mortality (6% vs 2%) between groups (≥ 65 yo vs <65 yo) were not statistically significant (P=0.38, P=0.70, P=0.11, P=0.48;respectively). Hospitalization and remission at 1, 3, and more than 5 years from biologics prescription were not statistically significant. However, age-stratified infections for pneumonia (PNA/COVID) resulted in statistical significance in those ≥80 yo (p<0.05). Multivariate analysis revealed that higher numbers of prescribed biologics since UC diagnosis were associated more with death (P=0.013) and neoplasm (P=0.046) in patients ≥65 yo. Conclusion: Age was not found to be an independent variable associated with any poor outcomes. Death and neoplasm events were associated with a greater number of prescribed biologics in those ≥ 65 yo and may reflect refractory versus longer disease course. Studies with larger samples of patients greater than 80 yo are required to confirm the association between PNA in this cohort. However, COVID was the etiology of the PNA. No difference in efficacy regarding remission, re-admission, or flare events was found between groups..