The effect of frailty and old age on the efficacy and safety of biologics and small molecules in inflammatory bowel disease : A pooled analysis of individual patient data

Inflammatory bowel disease (IBD) is a lifelong, progressively debilitating disease affecting the small and large intestines. The two distinct types of IBD are Crohn’s disease (CD) and Ulcerative colitis (UC). This autoimmune disease (where the body's immune system mistakenly attacks its own healthy tissues) often results in complications like narrowing of the intestinal lumen (the hollow space through the intestine) requiring surgeries to remove some part of the diseased intestine, hospitalizations and diminished quality of life. In the past decade, several highly effective advanced therapies including biologics (a treatment that uses substances derived from living organisms to treat disease) and small molecules (a drug that can enter cells easily because it is small) have been developed to manage this disease reducing the overall disease burden, improving the quality of life and reducing complications. However, these drugs are also associated with several potentially life-threatening adverse events. This is of particular concern in the old frail individuals with reduced ability to withstand additional health issues and increased vulnerability to a broad range of adverse health outcomes such as serious infection. Additionally, many of the elderly population have higher burden of the disease owing to longer disease duration and progressive nature of the disease. This may affect how this population responds to the medications. With advancements in the medical care and developments, the aged and frail population are increasing in number. This warrants an understanding of the effect of frailty on efficacy and safety of these advanced therapies which would be both effective in managing the disease and reducing risk of adverse events. The insights from this study will help select treatment options which are more suitable for this vulnerable group.