P4347 - Tofacitinib Use in Elderly With Ulcerative Colitis: Comparative Analysis of Safety and Efficacy

Ashraf Almomani, MD¹, Osama Sherjeel Khan, MD¹, Ritu NA. Channagiri, BS¹, Mohamad-Noor Abu-Hammour, MD², Rashid Abdel-Razeq, MD³, Zaid NA. Ansari, MD¹, Asif Hitawala, MD⁴, Akram Ahmad, MD¹, Prabhat NA. Kumar, MD⁵, Pravallika NA. Chadalavada, MD¹, Fernando NA. Castro, MD¹, Asad Ur Rahman, MD^1
1Cleveland Clinic Florida, Weston, FL; ²Cleveland Clinic Fairview, Cleveland, OH; ³Cleveland Clinic, Cleveland, OH; ⁴University of Maryland, Bethesda, MD; ⁵Cleveland Clinic Foundation, Cleveland, FL

Introduction: The use of Tofacitinib (Tc) for moderate-severe ulcerative colitis (UC) has been gaining more popularity since its introduction. However, its safety and efficacy in elderly population are not well described as these patients represent a small minority of patients in clinical trials. Comparative data regarding Tc use in elderly vs young adults with UC are lacking

Methods: In this multicenter retrospective cohort study of UC patients presenting to tertiary care locations (OH, FL) between January 2018 to August 2023, participants were classified into young (< 50) or old (≥50 years) at the time of receiving Tc. Exclusion criteria included alternative causes of colitis, Tc indication other than UC or combination of biologics. The primary outcome was composite end-point remission defined as steroid-free clinical remission (PRO2 score) in addition to biochemical remission or endoscopic remission, measured at 52 weeks. Secondary outcomes were biochemical response, biochemical remission, endoscopic remission, adverse events and hospitalizations. Outcomes for patients who discontinued Tc before the 52-week mark were measured provided no other biological agent was used within the study period. Patients who received another biologic or had colectomy after Tc within the study period were considered treatment failure

Results: 804 patients were screened and 103 patients (71 young, 32 old) were included in the final analysis (Figure 1.1). Baseline characteristics of the study population were obtained (Table 1). The mean age at Tc initiation was 61.25 years in the older group and 25.82 years in the younger group. Higher Charlson score was seen in the older group (2.69 vs 0.2667, p< 0.0001), however; baseline UC severity, phenotype and duration were similar for both groups. The primary outcome of composite end-point remission (53.13% vs 35.21%, p=0.05) and the secondary outcomes of biochemical remission and endoscopic remission were also similar. There was no significant increase in the number of hospitalizations or total rate of adverse events after Tc introduction in the older population. No cases of venous thromboembolism or death were identified in the study population. In the univariate and multivariate analysis, age and Charleson score were not predictive of treatment response (Figure1.2)

Discussion: Tofacitinib has similar efficacy profiles in older individuals compared to the younger patients with UC, without an apparent increase in the rates of adverse events despite the higher comorbidity index



Disclosures:


Ashraf Almomani, MD¹, Osama Sherjeel Khan, MD¹, Ritu NA. Channagiri, BS¹, Mohamad-Noor Abu-Hammour, MD², Rashid Abdel-Razeq, MD³, Zaid NA. Ansari, MD¹, Asif Hitawala, MD⁴, Akram Ahmad, MD¹, Prabhat NA. Kumar, MD⁵, Pravallika NA. Chadalavada, MD¹, Fernando NA. Castro, MD¹, Asad Ur Rahman, MD¹. P4347 - Tofacitinib Use in Elderly With Ulcerative Colitis: Comparative Analysis of Safety and Efficacy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.