We know little about the comparative risk of infections with various biologic agents in older adults with inflammatory bowel diseases (IBD). Thus, a recent study assessed the comparative safety of biologic agents in older IBD patients with varying comorbidity burdens.

It used data from a large, national commercial insurance plan in the United States to identify patients ≥60 years with IBD who newly initiated tumor necrosis factor-α antagonists (anti-TNF), vedolizumab, or ustekinumab. 

The study used the Charlson Co-morbidity Index (CCI) to define Comorbidity. The primary outcome was infection-related hospitalizations. 

The findings were as follows-

• The study included 2369, 972, and 352 patients in the anti-TNF, vedolizumab, and ustekinumab cohorts, respectively, with a mean age of 67 years.
• Patients initiating vedolizumab and ustekinumab showed a similar overall rate of infection-related hospitalizations as anti-TNF agents.
• Among patients with a CCI >1, both ustekinumab and vedolizumab showed a significantly lower rate of infection-related hospitalizations than anti-TNFs.
• However, patients with a CCI ≤1 showed no difference.

Thus, this study proves that among adults ≥60 years with IBD initiating biologic therapy, both vedolizumab and ustekinumab cause lower rates of infection-related hospitalizations than anti-TNF therapy for those with high comorbidity burden.

Source: Cheng D, Kochar B, Cai T, et al. Am J Gastroenterol. 2022 Jul 20. doi: 10.14309/ajg.0000000000001907.