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Significant Risk of Life Threatening Infections in Elderly Patients With Inflammatory Bowel Disease Receiving Anti-TNF Therapy

Clinical Gastroenterology and Hepatology, Volume 13, Issue 7, July 2015, Pages 1385 - 1386

Introduction

Anti tumour necrosis factor (anti-TNF) is highly effective in inflammatory bowel disease (IBD) but has been associated with a risk of infectious complications, particularly in patients with advanced age.

Aims

To determine the risk of infectious complications in our elderly patients exposed to anti-TNF therapy.

Methods

This is a retrospective study carried out in the University of Malaya Medical Centre, Kuala Lumpur where all patients diagnosed with IBD on anti-TNF were recruited. Dose and duration of anti-TNF, concomitant medications and infectious complications (non IBD related) were recorded.

Results

349 patients with confirmed IBD who were actively under follow up as from January 2014-2015 were identified. Of all patients who received anti-TNF, 71 were <60 years, 3 were ≥60 years. There was no significant difference in the use of concomitant immunomodulators in the two age groups. Infectious complications were seen in of 9(12.7%) in the younger group and 3(100%) in the elderly group. In the young age group, only one (1.4%) died from nosocomial pneumonia following an iatrogenic pneumothorax. 2 patients developed pneumonia (successfully treated) and 6 patients developed shingles. In contrast, all three (100%) of the elderly patients had significant infectious complications; one had disseminated Tuberculosis, one died following nosocomial pneumonia and one developed multiple opportunistic infections (pneumocystis pneumonia, cryptococcal meningitis).

Conclusions

Anti-TNF has to be used with extreme caution and ideally avoided in elderly patients with IBD.