Indications and safety of newer IBD treatments in the older patient.

Q1 Medicine Current Gastroenterology Reports Pub Date : 2023-07-01 DOI:10.1007/s11894-023-00874-9

Benjamin Clement, Kara De Felice, Anita Afzali

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Abstract

Purpose of review: Treatment of inflammatory bowel disease (IBD) in the elderly requires special attention to treatment efficacy while considering drug safety, other medical comorbidities, and the patients' risk for treatment related adverse events. In this article, we reviewed the indications and safety of the newer IBD therapies in the older IBD patient beyond anti-TNF agents, thiopurines, and corticosteroids.

Recent findings: Vedolizumab, ustekinumab, and risankizumab have favorable side effect profiles with regards to infections and malignancy. Ozanimod has a favorable side effect profile with regards to infection and malignancy, however cardiac events and macular edema are potential risks. Tofacitinib and upadacitinib are associated with an increased risk of serious infections, herpes zoster, malignancy, and have potential for an increased risk of cardiac events and thrombosis. From a safety profile perspective, vedolizumab, ustekinumab, and risankizumab should be considered first line treatment options for moderate-to-severe IBD in the elderly. Risk-benefit discussions are indicated for ozanimod, tofacitinib, and upadacitinib.

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老年患者新IBD治疗的适应症和安全性。

综述目的:老年炎症性肠病(IBD)的治疗需要特别关注治疗疗效，同时考虑药物安全性、其他医疗合并症以及患者治疗相关不良事件的风险。在这篇文章中，我们回顾了除抗肿瘤坏死因子、硫嘌呤和皮质类固醇外，老年IBD患者的新IBD治疗的适应症和安全性。最近的研究发现:Vedolizumab, ustekinumab和risankizumab在感染和恶性肿瘤方面具有良好的副作用。Ozanimod在感染和恶性肿瘤方面具有良好的副作用，但心脏事件和黄斑水肿是潜在的风险。托法替尼和upadacitinib与严重感染、带状疱疹、恶性肿瘤的风险增加有关，并有可能增加心脏事件和血栓形成的风险。从安全性角度来看，vedolizumab、ustekinumab和risankizumab应被视为老年人中重度IBD的一线治疗选择。对ozanimod、tofacitinib和upadacitinib进行了风险-收益讨论。

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来源期刊

Current Gastroenterology Reports Medicine-Gastroenterology

CiteScore

7.80

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0.00%

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期刊介绍： As the field of gastroenterology and hepatology rapidly evolves, the wealth of published literature can be overwhelming. The aim of the journal is to help readers stay abreast of such advances by offering authoritative, systematic reviews by leading experts. We accomplish this aim by appointing Section Editors who invite international experts to contribute review articles that highlight recent developments and important papers published in the past year. Major topics in gastroenterology are covered, including pediatric gastroenterology, neuromuscular disorders, infections, nutrition, and inflammatory bowel disease. These reviews provide clear, insightful summaries of expert perspectives relevant to clinical practice. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.

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