P0680Comparative tolerance of anti-tnf agents in young and older patients with Inflammatory Bowel Disease

Abstract Background Inflammatory bowel diseases (IBD) represent a major therapeutic challenge and require long-term management. Anti-tnfs agents have improved outcomes, but their tolerance may vary with age. This study compares the tolerance of anti-tnf therapy in young (50 years) and older (≥50 years) patients. Methods This was a single-centre retrospective study including 1,806 IBD patients, comprising 1,204 cases of Crohn’s disease (66.7%) and 602 cases of Ulcerative Colitis (33.3%). Among them, 246 patients (13.6%) were treated with anti-tnf agents: 165 aged 50 years (67.1%) and 81 aged ≥50 years (32.9%). Data analysed included phenotype, disease location, treatment indication, allergic, infectious or immunological adverse events, complications, loss of response, and therapeutic adjustments. Results Crohn’s disease predominated in both groups: 91.5% in younger patients (n = 151) and 85.2% in older patients (n = 69), whereas Ulcerative Colitis was slightly more frequent in the ≥50 group (14.8% vs 8.5%). Female sex was predominant in both groups: 59.4% in patients 50 years and 58% in those ≥50 years. Indications for anti-tnf therapy differed slightly between age groups. In patients 50 years, perianal disease was the leading indication (47.9%), followed by failure or intolerance to immunosuppressants (33.9%) and postoperative recurrence (6.7%). In older patients, failure or intolerance to immunosuppressants was predominant (27.1%), followed by perianal disease (37%) and postoperative recurrence (14.8%). Allergic reactions were comparable: 4.8% in younger patients and 9.9% in older patients, mostly mild. Complications occurred in 7.9% of younger patients and 9.9% of older patients, with abscesses predominating before 50 years (4.2%) and strictures after 50 years (6.2%). Opportunistic infections were observed in 9.7% of younger and 13.6% of older patients, mainly tuberculosis, followed by herpes, shingles and candidiasis. These infections occurred predominantly under infliximab. Secondary loss of response occurred in 11.5% of younger patients and 9.9% of older patients. Therapeutic switching was more frequent in younger patients (25.4% vs 18.5%), mainly towards ustekinumab. Conclusion Anti-tnf therapy shows similar tolerance in young and older IBD patients, with findings consistent with the literature; opportunistic infections, mainly tuberculosis, are the leading adverse events and justify systematic screening and close monitoring, while an individualised assessment of the benefit–risk balance remains essential in older patients. Reference: 1-Rentsch C. et al. Anti-TNF therapy and risk of serious infection in elderly IBD patients, Journal of Crohn’s and Colitis, 2020. Conflict of interest: Elbasri, Ikram: No conflict of interest Lagdali, Nawal: No conflict of interest Sabbah, Selma: No conflict of interest kadiri, maryeme: No conflict of interest Chabib, Fatima-Zahra: No conflict of interest mohamed, borahma: No conflict of interest Ajana, Fatima Zohra: No conflict of interest