{"title":"对老年和非老年克罗恩病患者使用乌司替尼和韦多珠单抗的短期有效性和安全性：一项比较研究。","authors":"Lior Dar, Uria Shani, Arad Dotan, Offir Ukashi, Shomron Ben-Horin, Uri Kopylov, Asaf Levartovsky","doi":"10.1177/17562848241299752","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) presents unique challenges in elderly patients due to comorbidities and treatment-related risks.</p><p><strong>Objectives: </strong>This study evaluates ustekinumab (UST) and vedolizumab (VDZ) efficacy and safety in elderly Crohn's disease (CD) patients.</p><p><strong>Design: </strong>A retrospective cohort study at a tertiary medical center.</p><p><strong>Methods: </strong>CD patients aged ⩾60 years (elderly) treated with UST, compared to non-elderly (<60 years) patients treated with UST and elderly patients treated with VDZ. Clinical response was evaluated using the Harvey-Bradshaw index (HBI) and clinical biomarkers, alongside monitoring steroid use, hospitalization rates, treatment persistence, and surgical interventions.</p><p><strong>Results: </strong>The study included 166 CD patients: 32 elderly and 65 non-elderly patients treated with UST, and 69 elderly patients treated with VDZ. The mean duration of follow-up was 10.8 ± 2.8 months in the non-elderly group, 9.97 ± 3.28 months in the elderly UST group, and 10.0 ± 3.29 months in the VDZ group. Elderly UST patients were more likely to receive corticosteroids at initiation than non-elderly UST patients (44% vs 14%, <i>p</i> = 0.001). At 12 months, clinical response rates did not significantly differ between elderly and non-elderly UST groups, respectively (48% vs 40%, <i>p</i> = 0.5). However, elderly UST patients exhibited higher hospitalization rates over time compared to non-elderly UST patients (6-month: 19% vs 6.2%, <i>p</i> = 0.077; 12-month: 19% vs 4.6%, <i>p</i> = 0.055; log-rank <i>p</i> = 0.004). No significant differences were observed in clinical response and remission rates between elderly UST and elderly VDZ patients at 6 and 12 months. At 6 months, a higher hospitalization rate was observed in the UST group (19% vs 4.3% <i>p</i> = 0.027), but this difference did not persist over time.</p><p><strong>Conclusion: </strong>UST and VDZ are effective and safe treatments for elderly CD patients, despite higher hospitalization rates compared to non-elderly patients, likely due to age-related complications.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"17 ","pages":"17562848241299752"},"PeriodicalIF":3.9000,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577457/pdf/","citationCount":"0","resultStr":"{\"title\":\"Short-term effectiveness and safety of ustekinumab and vedolizumab in elderly and non-elderly patients with Crohn's disease: a comparative study.\",\"authors\":\"Lior Dar, Uria Shani, Arad Dotan, Offir Ukashi, Shomron Ben-Horin, Uri Kopylov, Asaf Levartovsky\",\"doi\":\"10.1177/17562848241299752\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) presents unique challenges in elderly patients due to comorbidities and treatment-related risks.</p><p><strong>Objectives: </strong>This study evaluates ustekinumab (UST) and vedolizumab (VDZ) efficacy and safety in elderly Crohn's disease (CD) patients.</p><p><strong>Design: </strong>A retrospective cohort study at a tertiary medical center.</p><p><strong>Methods: </strong>CD patients aged ⩾60 years (elderly) treated with UST, compared to non-elderly (<60 years) patients treated with UST and elderly patients treated with VDZ. Clinical response was evaluated using the Harvey-Bradshaw index (HBI) and clinical biomarkers, alongside monitoring steroid use, hospitalization rates, treatment persistence, and surgical interventions.</p><p><strong>Results: </strong>The study included 166 CD patients: 32 elderly and 65 non-elderly patients treated with UST, and 69 elderly patients treated with VDZ. The mean duration of follow-up was 10.8 ± 2.8 months in the non-elderly group, 9.97 ± 3.28 months in the elderly UST group, and 10.0 ± 3.29 months in the VDZ group. Elderly UST patients were more likely to receive corticosteroids at initiation than non-elderly UST patients (44% vs 14%, <i>p</i> = 0.001). At 12 months, clinical response rates did not significantly differ between elderly and non-elderly UST groups, respectively (48% vs 40%, <i>p</i> = 0.5). However, elderly UST patients exhibited higher hospitalization rates over time compared to non-elderly UST patients (6-month: 19% vs 6.2%, <i>p</i> = 0.077; 12-month: 19% vs 4.6%, <i>p</i> = 0.055; log-rank <i>p</i> = 0.004). No significant differences were observed in clinical response and remission rates between elderly UST and elderly VDZ patients at 6 and 12 months. 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引用次数: 0
摘要
背景：由于合并症和治疗相关风险，炎症性肠病（IBD）给老年患者带来了独特的挑战：本研究评估乌司替尼（UST）和维妥珠单抗（VDZ）在老年克罗恩病（CD）患者中的疗效和安全性：设计：在一家三级医疗中心进行的一项回顾性队列研究：方法：年龄在60岁以上（老年）接受UST治疗的CD患者与非老年患者进行比较：研究包括 166 名 CD 患者：32名老年患者和65名非老年患者接受了UST治疗，69名老年患者接受了VDZ治疗。非老年组的平均随访时间为（10.8±2.8）个月，老年 UST 组为（9.97±3.28）个月，VDZ 组为（10.0±3.29）个月。与非老年 UST 患者相比，老年 UST 患者更有可能在开始治疗时接受皮质类固醇治疗（44% 对 14%，P = 0.001）。12 个月后，老年 UST 组和非老年 UST 组的临床反应率没有明显差异（48% vs 40%，p = 0.5）。然而，与非老年 UST 患者相比，老年 UST 患者的住院率较高（6 个月：19% vs 6.2%，p = 0.5）：19% vs 6.2%，p = 0.077；12 个月：19% vs 4.6%，p = 0.077：19% vs 4.6%，p = 0.055；log-rank p = 0.004）。在6个月和12个月时，老年UST患者和老年VDZ患者的临床应答率和缓解率无明显差异。在6个月时，观察到UST组的住院率较高（19% vs 4.3% p = 0.027），但这种差异并没有随着时间的推移而持续：结论：UST和VDZ对老年CD患者来说是有效且安全的治疗方法，尽管与非老年患者相比住院率较高，这可能是由于年龄相关并发症所致。
Short-term effectiveness and safety of ustekinumab and vedolizumab in elderly and non-elderly patients with Crohn's disease: a comparative study.
Background: Inflammatory bowel disease (IBD) presents unique challenges in elderly patients due to comorbidities and treatment-related risks.
Objectives: This study evaluates ustekinumab (UST) and vedolizumab (VDZ) efficacy and safety in elderly Crohn's disease (CD) patients.
Design: A retrospective cohort study at a tertiary medical center.
Methods: CD patients aged ⩾60 years (elderly) treated with UST, compared to non-elderly (<60 years) patients treated with UST and elderly patients treated with VDZ. Clinical response was evaluated using the Harvey-Bradshaw index (HBI) and clinical biomarkers, alongside monitoring steroid use, hospitalization rates, treatment persistence, and surgical interventions.
Results: The study included 166 CD patients: 32 elderly and 65 non-elderly patients treated with UST, and 69 elderly patients treated with VDZ. The mean duration of follow-up was 10.8 ± 2.8 months in the non-elderly group, 9.97 ± 3.28 months in the elderly UST group, and 10.0 ± 3.29 months in the VDZ group. Elderly UST patients were more likely to receive corticosteroids at initiation than non-elderly UST patients (44% vs 14%, p = 0.001). At 12 months, clinical response rates did not significantly differ between elderly and non-elderly UST groups, respectively (48% vs 40%, p = 0.5). However, elderly UST patients exhibited higher hospitalization rates over time compared to non-elderly UST patients (6-month: 19% vs 6.2%, p = 0.077; 12-month: 19% vs 4.6%, p = 0.055; log-rank p = 0.004). No significant differences were observed in clinical response and remission rates between elderly UST and elderly VDZ patients at 6 and 12 months. At 6 months, a higher hospitalization rate was observed in the UST group (19% vs 4.3% p = 0.027), but this difference did not persist over time.
Conclusion: UST and VDZ are effective and safe treatments for elderly CD patients, despite higher hospitalization rates compared to non-elderly patients, likely due to age-related complications.
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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