PMO-25 Age may not impact biologic treatment failure in IBD: A retrospective single centre cohort study

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Introduction Research of age-related treatment failure with biologics for inflammatory bowel disease (IBD) is limited. Previous studies have suggested a higher failure risk for Adults >60 years (>60), but focused on anti-TNFα agents. Newer biologics are revolutionising treatment for Adults with IBD, but to date treatment failure or intolerance in the >60 is poorly understood. RAB-IBD (Retrospective analysis of biologic treatment failure in IBD) at Royal Wolverhampton NHS Trust, is a real-life, longitudinal retrospective single-centre study comparing failure rates for biologics/biosimilar agents. These include anti-TNFα’s, integrin-inhibitors, interleukins-inhibitors and JAK-inhibitors. The primary outcome was to evaluate whether treatment failure at 12 months was impacted by age (>60s versus <60s). The secondary outcomes were to analyse if failure to complete 12 months of therapy were a result of the; type of biologic used, use of concomitant drugs, or demographic factors. Methods 632 patients were identified from the Trust IBD database, who were initiated on biologics from January 2015 to December 2019. 465 matched our inclusion and exclusion criteria. Baseline characteristics, such as gender, biologic, type of IBD and number of biologics used previously, were matched to produce two cohorts, each of 98 participants comprising >60s and <60s. Results Adverse effects, hospitalisation and need for emergency surgery was seen in 5.1% of under 60s (n=5) and 13.3% of over 60s (n=13). There was no significant difference in the proportion of patients who failed to complete 12 months of biologic treatment from the >60s (n=20, 20.4%) versus <60s (n=12, 12.2%) (OR 1.838, p=0.126). A larger proportion of biologic failure was seen in those on anti-TNFα vs. non-anti-TNFα biologics, but this was not significant (OR 2.35, p=0.051). IBD type (Crohn’s vs. Colitis) was not a predictor of biological failure (OR 1.856, p=0.176), nor was previous biologic use (OR 0.644, p=0.118); concomitant thiopurines/methotrexate (OR 0.46, p=0.134); co-morbidities (OR 0.834, p<=0.752); smoking status (OR 0.956, p=0.888); severity score (OR 0.939, p=0.420); baseline CRP (OR 1.024, p=0.250); faecal calprotectin (OR 1.00, p=0.746). Risk of biological failure at 12 months was greater in women than in men (OR 2.5, p=0.023). Conclusions Age is not an independent predictor of pooled biological failure at 12 months post-initiation. This finding may be factored in when personalised treatment approaches are sought for >60s who are not respondent to conventional therapy. However, more research is required in a higher-powered study to investigate whether treatment failure is influenced by various demographic factors and by biologic type.

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