DOP57 Vedolizumab has similar efficacy rates in young and elderly patients: A binational, multicentre, retrospective case–control study

Abstract Background Treatment of inflammatory bowel diseases (IBD) is associated with multiple side effects, such as malignancies and infections, that may be more common in the elderly population. The aim of this study was to compare the safety and efficacy of vedolizumab (VDZ) in young and elderly patients. Methods This is a binational, multicentre, retrospective, case–control study consisting of patients from multiple centres in Israel and from Edinburgh, UK. IBD patients in whom VDZ treatment was initiated during 2015–2019, and were followed for at least 14 weeks, were included in the study according to their age groups: ≤40 years or ≥60 years. Patients were matched for disease duration, classification and severity. Results We recruited 144 patients (82 CD and 62 UC) to the elderly cohort and 140 patients (83 CD and 57 UC) to the young cohort. The respective average age was 70.2 ± 7.3 years and 29.6 ± 5.7 years. Elderly patients had significantly more cardiovascular, metabolic and respiratory co-morbidities and had less prior exposure to anti-TNF agents compared with the young cohort (CD: 51% vs. 88%, p < 0.001; UC: 47% vs. 70%, p = 0.03). Clinical and endoscopic responses were comparable between the groups at Weeks 14 and 52 among elderly and young (Week 52 remission: CD: 40% vs. 35%, p = 0.7; UC: 48% vs. 51%, p = 0.84) (Figure 1). However, the use of more than one anti-TNF agent was an independent predictor of poor response and remission rates to VDZ at all time points among the elderly (OR 0.13; 95% CI 0.03–0.69). A total of 49 adverse events were documented, 23 (16%) in the young cohort and 26 (18%) in the elderly cohort (p = 0.5). Overall there were significantly more infections in the elderly cohort (3 (2%) vs. 17 (12%), p = 0.002) and included nasopharyngeal, urinary, skin and Clostridium difficile infections. None of them was fatal but one patient stopped treatment due to urinary sepsis. There were significantly more non-specific adverse events such as headache and myalgia in the young cohort (8% vs. 2%, p = 0.03). Six patients (4%) in the young cohort required drug discontinuation due to adverse events compared with 4 patients (3%) in the elderly cohort (p = 0.5). The reasons for discontinuation were similar between the groups. Conclusion VDZ is equally effective in elderly and young IBD patients. This study shows an increased risk of overall infections in the elderly cohort, it is unclear whether these are related to VDZ treatment or the age and background diseases of these patients. In elderly patients, the use of VDZ before anti-TNF therapy may improve response and remission rates.

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744. Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine and Influenza Vaccine Against Pneumococcal Pneumonia Among Elderly Patients Aged 65 Years and Older in the Republic of Korea: A Case–Control Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.751 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S267-S267

Author(s):

Jong Hun Kim ◽

Byung Chul Chun ◽

Joon Young Song ◽

Hyo Youl Kim ◽

In-Gyu Bae ◽

...

Keyword(s):

Elderly Patients ◽

Elderly Population ◽

Case Control Study ◽

The Elderly ◽

Case Control ◽

Polysaccharide Vaccine ◽

Vaccine Effectiveness ◽

Pneumococcal Polysaccharide Vaccine ◽

The Republic ◽

Control Study

Abstract Background The national immunization program (NIP) of annual influenza vaccination to the elderly population (≥65 years of age) in the Republic of Korea (ROK) has been implemented since 1987. Recently, the 23-valent pneumococcal polysaccharide vaccine (PPV23) through the NIP has been provided to the elderly population in the ROK since May 2013. The aim of this study was to assess PPV23 and influenza vaccine (IV) effectiveness in preventing pneumococcal pneumonia (PP) among elderly patients ≥65 years of age. Methods A case–control study using a hospital-based cohort was conducted. Cases of PP including bacteremic PP and nonbacteremic PP were collected from 14 hospitals in the pneumococcal diseases surveillance program from March 2013 to October 2015. Controls matched by age and sex in the same hospital were selected. Demographic, clinical information, and vaccination histories were collected. Previous immunization was categorized into “vaccinated” if a patient had received vaccines as follows: PPV23 (4 weeks to 5 years) and IV (2 weeks to 6 months) prior to the diagnosis of PP for case patients and prior to the hospital admission for control patients. Adjusted odds ratio (OR) was calculated, controlling for underlying medical conditions. Vaccine effectiveness was defined as (1 – OR) × 100. Results During the study period, a total of 661 cases (104 bacteremic PP cases and 557 nonbacteremic PP cases) and 661 controls were enrolled for analyses. For overall patients ≥65 years of age, there was no significant vaccine effectiveness against PP. For young elderly patients with 65–74 years, IV alone (1.2%, [95% confidence interval (CI) −95.3% to 50.0%]) and PPV23 alone (21.9%, [95% CI −39.0% to 56.1%]) were not effective. However, significant vaccine effectiveness of PPV23 plus IV against PP was noted (54.4%, [95% CI 6.9–77.7%], P = 0.031). For older elderly patients ≥75 years of age, no significant vaccine effectiveness was observed. Conclusion Our study indicates that PPV23 plus IV may be effective in preventing PP among young elderly patients with 65–74 years, suggesting additive benefits of influenza plus PPV23 vaccination. Further studies are required to confirm the persistent additive protective effectiveness. Disclosures All authors: No reported disclosures.

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Efficacy and safety of vedolizumab in elderly patients with inflammatory bowel disease: a matched case–control study

Gastroenterology Report ◽

10.1093/gastro/goz041 ◽

2019 ◽

Vol 8 (4) ◽

pp. 306-311 ◽

Cited By ~ 1

Author(s):

Preeti Shashi ◽

Dharmesh Gopalakrishnan ◽

Malav P Parikh ◽

Bo Shen ◽

Gursimran Kochhar

Keyword(s):

Inflammatory Bowel Disease ◽

Elderly Patients ◽

Case Control Study ◽

The Elderly ◽

Mucosal Healing ◽

Case Control ◽

Elderly Group ◽

Efficacy And Safety ◽

Inflammatory Bowel ◽

Control Study

Abstract Background Vedolizumab was demonstrated to be safe and effective in adults with moderately to severely active inflammatory bowel disease (IBD) in clinical trials. However, there are limited data regarding its efficacy and safety in elderly patients. Methods This was a case–control study comparing the efficacy (measured by rates of mucosal healing and need for IBD surgery) and safety of vedolizumab in IBD among patients ≥65 years of age (the elderly group) vs those <65 years (the control group). The two groups were matched individually on a 1:4 ratio based on gender and type of IBD. Conditional logistic regression was used for stratified analysis to calculate odds ratios and confidence intervals. Results We included 25 IBD patients in the elderly group and 100 matched patients in the comparison group. Eighty patients had Crohn’s disease and 45 had ulcerative colitis. At baseline, the groups were comparable with regard to duration of IBD, prior anti-TNF therapy, and prior IBD surgery. The rate of mucosal healing on follow-up endoscopy was comparable between the elderly and control groups (50% vs 53%, P = 0.507). Although more patients in the elderly group required IBD-related surgery while on vedolizumab, the difference did not reach statistical significance (40% vs 19%, P = 0.282). Rates of vedolizumab-related adverse effects—rash, arthralgia, infections, infusion reactions, and dyspnea—were comparable between the two groups (all P > 0.05). Conclusions In a real-world setting, vedolizumab was demonstrated to have an efficacy and safety profile among elderly IBD patients that were comparable to younger controls.

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Patterns and injuries associated with orbital wall fractures in elderly patients who visited the emergency room: a retrospective case–control study

BMJ Open ◽

10.1136/bmjopen-2016-011110 ◽

2016 ◽

Vol 6 (9) ◽

pp. e011110 ◽

Cited By ~ 4

Author(s):

Youn-Jung Kim ◽

Shin Ahn ◽

Dong-Woo Seo ◽

Chang Hwan Sohn ◽

Hyung-Joo Lee ◽

...

Keyword(s):

Elderly Patients ◽

Emergency Room ◽

Case Control Study ◽

Case Control ◽

Retrospective Case ◽

Orbital Wall ◽

Control Study

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Pediatric perioperative adverse events requiring rapid response: a retrospective case-control study

Pediatric Anesthesia ◽

10.1111/pan.12922 ◽

2016 ◽

Vol 26 (7) ◽

pp. 734-741 ◽

Cited By ~ 18

Author(s):

Laura E. Schleelein ◽

Ariel M. Vincent ◽

Abbas F. Jawad ◽

Eric Y. Pruitt ◽

Genna D. Kreher ◽

...

Keyword(s):

Adverse Events ◽

Case Control Study ◽

Case Control ◽

Rapid Response ◽

Retrospective Case ◽

Control Study

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Differences in Preoperative Gastric Ultrasound Findings Between Old and Young Surgical Patients: A Retrospective Case-Control Study

10.21203/rs.3.rs-1137760/v1 ◽

2021 ◽

Author(s):

Jin Hee Ahn ◽

Jae-Geum Shim ◽

Sung Hyun Lee ◽

Kyoung-Ho Ryu ◽

Mi Yeon Lee ◽

...

Keyword(s):

Elderly Patients ◽

Case Control Study ◽

Young Patients ◽

The Elderly ◽

Young Group ◽

Pulmonary Aspiration ◽

Elderly Group ◽

Retrospective Case ◽

Cutoff Values ◽

Control Study

Abstract Background: Most gastric ultrasound studies have been conducted in young middle-aged patients. Although age is known to influence gastric ultrasound, comparisons of gastric ultrasound in elderly patients with young patients have not been well elucidated. This study aimed to 1) compare gastric ultrasound assessments between young and elderly patients, 2) determine whether the CSA cutoff values for elderly and young patients should be different, and 3) suggest CSA cutoff values for elderly patients.Methods: This retrospective case-control study evaluated the data of 120 patients who underwent elective surgery under general anesthesia between July 2019 and August 2020. Demographic and gastric ultrasound assessment data were retrieved. Patients were divided into the elderly group (n = 58, age: ≥65 years) and young group (n = 62, age: <65 years). The antral cross-sectional area (CSA) in the supine and right lateral decubitus positions (RLDP), semiquantitative three-point Perlas grade (grades 0, 1, and 2), and gastric volume were determined. CSAs according to different Perlas grades were compared between the two groups. The CSA cutoff values for predicting a high risk of pulmonary aspiration in both the groups were determined. Results: Among patients with Perlas grade 0 (empty stomach), the CSA supine and CSA RLDP were greater in the elderly group than in the young group (CSA supine: 5.12 ± 1.99 cm2 vs. 3.92 ± 0.19 cm2, P = 0.002, and CSA RLDP: 6.24 ± 0.43 cm2 vs. 4.58 ± 0.21 cm2, P = 0.002). The specificity, positive predictive value, and accuracy of the CSA decreased when the CSA cutoff value for the young group (CSA RLDP: 6.92 cm2) was applied to the elderly group. The CSA cutoff values for the elderly group were: CSA supine, 6.92 cm2 and CSA RLDP, 10.65 cm2.Conclusions: The CSA of the empty stomach was greater in elderly patients than in young patients. The CSA cutoff values for predicting pulmonary aspiration risk in elderly and young patients should be differentiated. We suggest that the following CSA cutoff values should be used for predicting pulmonary aspiration risk in elderly patients: CSA supine, 6.92 cm2 and CSA RLDP, 10.65 cm2.

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Abstract 19974: Medicalized Prehospital Care in the Elderly: Facing Age Discrimination

Circulation ◽

10.1161/circ.132.suppl_3.19974 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Eric Wiel ◽

Nicolas Segal ◽

Christophe Di Pompéo ◽

Jean-Baptiste Marc ◽

Carine Vanderstraeten ◽

...

Keyword(s):

Elderly Patients ◽

Case Control Study ◽

Prehospital Care ◽

Cerebral Performance Category ◽

The Elderly ◽

Case Control ◽

Spontaneous Circulation ◽

Vital Status ◽

Lower Survival Rate ◽

Control Study

Introduction: Few studies report results on cardiac arrests (CA) care in the elderly. Even if age is not considered as an essential prognostic factor some studies questioned if cardiopulmonary resuscitation (CPR) in the elderly could be futile. Nevertheless in daily clinical practice, age seems to be an important factor conditioning CA care. Hypothesis: The aim of this case-control study was to compare out of hospital cardiac arrest care and outcome between young (<65 years old) and elderly patients. Methods: We performed a prospective case-control study based on data extracted from the French National CA registry. All adult patients (>18 years old) with CA recorded between July 2011 and May 2014 were included. Each elderly (>=65 years old) patient (case) was matched on 3 criteria: sex, initial cardiac rhythm, and the no-flow duration. Results: We studied 4,347 pairs. We significantly found less BLS starting, ACLS duration, mobile medical team (MMT) automated chest compression, MMT ventilation and MMT epinephrine injection in the elderly. Statistical differences were also observed for return of spontaneous circulation (ROSC) (OR=0.84[0.77-0.92]), transport to hospital (OR=0.58[0.51-0.61]), vital status at hospital admission (OR=0.55[0.50-0.60]), vital status at Day 30 (OR=0.42[0.35-0.50]), and Cerebral Performance Category (CPC) at Day 30 (OR=0.44[0.37-0.53]). Conclusions: All CA guidelines, ethical statement, clinical procedures do not propose age as a discrimination criterion in OHCA care. However, our study shows that with similar CA conditions, elderly patients are victims of medical discrimination by a shorter duration and less intensive care leading to a lower survival rate compared to young people.

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Acute myocardial infarction in the elderly. A case-control study with a younger population and review of literature

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2006.537 ◽

2016 ◽

Vol 66 (1) ◽

Author(s):

Fabrizio Corsini ◽

Anna Scaglione ◽

Maria Iacomino ◽

Giuseppe Mascia ◽

Saverio Melorio ◽

...

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Case Control Study ◽

The Elderly ◽

Case Control ◽

Response To Treatment ◽

Control Group ◽

Retrospective Case ◽

Old Patients ◽

Control Study

Background: ST elevation myocardial infarction (STEMI) in old and old-old patients presents several peculiarities in natural history, delay of hospitalization and response to treatment. Aim of this retrospective case control study was to determine presentation, complications and management of elderly patients with STEMI compared to a younger population. Methods: 462 patients (205 M and 257 F) aged ≥75 years, hospitalized in CCU between 1999 and 2003 for STEMI, were valuated. The control group consisted of 490 consecutive patients (268 M and 222 F) aged 50-70 years. Attention was focused on clinical presentation, complications, management and outcome in elderly compared with younger patients. Results: The mean interval between the onset of symptoms and the arrive in CCU was of 9 hour in the elderly compared to 4,5 hour in the control. Chest pain was less frequent (50% vs 90%) in the elderly; the prevalence of dyspnoea and neurological symptoms was higher in patients >75 years (30% vs 15% and 25% vs 10%). In the elderly, previous angina and AMI, cerebral and peripheral vascular diseases, peripheral and renal failure were frequent. Early severe complications prevailed in the elderly. Thrombolysis was performed only in 39% of the elderly compared to 65% of the control. Significantly higher was cerebral haemorrhage after thrombolysis (4,9% vs 1,8%). Comparable were the mayor extra cranial bleedings. Primary or facilitated PTCA was performed in few patients in the last year. Two weeks mortality was 20%, compared to 6,5% in the control group. Conclusion: The patientes >75 years with STEMI were hospitalized later, had atypical presentation with less chest pain and more cardiac failure, were less likely to receive thrombolysis, had more complications and more cerebral bleedings. Elderly had more associated diseases and in-hospital mortality was higher.

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