Anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events.

PURPOSE: To assess safety and effectiveness of anti-tumor necrosis factor (anti-TNF) therapy in IBD patients ≥ 60 years. METHODS: Ninety IBD patients ≥ 60 years at initiation of anti-TNF therapy, 145 IBD patients ≥ 60 years without anti-TNF therapy and 257 IBD patients < 60 years at initiation of anti-TNF therapy were retrospectively included in this multicentre study. Primary outcome was the occurrence of severe adverse events (SAEs), serious infections and malignancies. Secondary outcome was effectiveness of therapy. Cox regression analyses were used to assess differences in safety and effectiveness. In safety analyses, first older patients with and without anti-TNF therapy and then older and younger patients with anti-TNF therapy were assessed. RESULTS: In older IBD patients, the use of anti-TNF therapy was associated with serious infections (aHR 3.920, 95% CI 1.185-12.973, p = .025). In anti-TNF-exposed patients, cardiovascular disease associated with serious infections (aHR 3.279, 95% CI 1.098-9.790, p = .033) and the presence of multiple comorbidities (aHR 9.138 (1.248-66.935), p = .029) with malignancies, while patient age did not associate with safety outcomes. Effectiveness of therapy was not affected by age or comorbidity. CONCLUSION: Older patients receiving anti-TNF therapy have a higher risk of serious infections compared with older IBD patients without anti-TNF therapy, but not compared with younger patients receiving anti-TNF therapy. However, in anti-TNF-exposed patients, comorbidity was found to be an indicator with regards to SAEs. Effectiveness was comparable between older and younger patients.

Decreased Risk of COPD Exacerbations in Obese Patients.

Survival in chronic obstructive pulmonary disease (COPD) is enhanced in obese patients, which is called the obesity paradox. Despite some theories, the precise mechanism remains unclear. Since COPD exacerbations play a major role in COPD survival, this study aimed to stratify patients into BMI classes and investigate exacerbation frequency, time to readmission and survival in patients hospitalized with a COPD exacerbation. Therefore, patients hospitalized with an exacerbation of COPD were categorized into BMI groups using cut-offs <18.5, 25, 30 and ≥35 kg/m2 for underweight, normal, overweight, moderately obese and severely obese groups and followed for five years. A total of 604 COPD patients was included. In comparison to normal weight patients, the 5-year exacerbation frequency was significantly decreased by 34-40% in obese patients depending on the BMI group (1.83 ± 1.60 per year in the normal weight group; overweight 1.60 ± 1.41; moderately obese 1.20 ± 1.18; severely obese 1.09 ± 1.13 per year; and 1.59 ± 1.30 in the underweight group). The time to readmission was up to 1.7 times longer for moderately obese patients compared to normal weight patients (954 ± 734 versus 564 ± 660 days). The data were supported by enhanced survival in obese patients and a regression analysis showing that both time to readmission and survival were associated with BMI independent of other possible confounders. In conclusion, this study shows a 'dose dependent' reduced exacerbation frequency and an increased time to readmission in obese patients admitted to the hospital with an exacerbation of COPD.