Agents In Elderly Patients Research Articles

An insight into pharmacokinetics and dose optimization of antimicrobials agents in elderly patients.

The global elderly population is on the rise, and infections tend to have a higher mortality rate among older individuals. Aging is associated with the progressive impairment of multi-organ function, which can impact the pharmacokinetics of antimicrobials, potentially leading to the failure of anti-infective therapy. With the increasing life expectancy, a significant growth in the elderly demographic, and the escalating costs of healthcare, gaining a thorough understanding of pharmacokinetic changes in the elderly holds crucial clinical significance. This review compiles findings from published studies, offering a comprehensive overview of the pharmacokinetics of various antimicrobials in both adults and the elderly. Furthermore, it delves into advancements in pharmacokinetic methods specific to the elderly population.

Safety of Perioperative Maintenance of Antiplatelet Agents in Elderly Patients Undergoing Lung Cancer Surgery.

The maintenance of antiplatelet therapy increases the risk of bleeding during lung cancer surgery. Conversely, the perioperative interruption of antiplatelet therapy may result in serious thrombotic complications. This study aimed to investigate the safety of continuing antiplatelet therapy in the context of lung cancer surgery. We retrospectively reviewed a cohort of 498 elderly patients who underwent surgery for lung cancer. These patients were categorized into 2 groups: group N, which did not receive antiplatelet therapy, and group A, which did. Group A was subsequently subdivided into group Am, where antiplatelet therapy was maintained, and group Ai, where antiplatelet therapy was interrupted. We compared the incidence of bleeding-related and thrombotic complications across the 3 groups. There were 387 patients in group N and 101 patients in group A (Ai: 70, Am: 31). No significant differences were found in intraoperative blood loss, thoracotomy conversion rates, transfusion requirements, volume of chest tube drainage, or reoperation rates for bleeding control between groups N and A or between groups Am and Ai. The duration of hospital stay was longer for group A compared to group N (7 days vs. 6 days, p=0.005), but there was no significant difference between groups Ai and Am. The incidence of cardiovascular or cerebrovascular complications did not differ significantly between groups Ai and Am. However, group Ai included a severe case of in-hospital ST-elevation myocardial infarction. The maintenance of antiplatelet therapy was found to be safe in terms of perioperative bleeding and thrombotic complications in elderly lung cancer surgery patients.

The efficacy and safety of venetoclax combined with demethylating agents in elderly patients with acute myeloid leukemia: a systematic review and meta-analysis.

The aim of this study was to evaluate the efficacy and adverse effects of venetoclax in combination with hypomethylating agents in elderly with acute myeloid leukemia. A comprehensive literature search identified related studies from PubMed, Medline, Embase, Scopus, and Cochrane Library. Overall complete remission (CR) and overall response rate (ORR) were applied to evaluate the efficacy of venetoclax in combination with hypomethylating agents in elderly with acute myeloid leukemia, and incidence of grade 3-4 adverse events were used to evaluate the safety. 10 studies, including a total of 930 patients, were identified in our study and analyzed using the random-effects model. Meta-analysis showed the pooled overall CR rate of 70% (95% CI: 63-77%), the pooled ORR rate of 53% (95% CI: 39-67%), and the median overall survival ranged from 7.7 to 16.9 months. A total of 6 studies reported related adverse events, mainly including thrombocytopenia, febrile neutropenia, neutropenia, leukopenia, anemia, and pneumonia. The pooled incidence of overall adverse events was 30% (95% CI: 22-38%), and all adverse events were tolerable and resolved with treatment. The combination of venetoclax and demethylating drugs has a good therapeutic effect on elderly patients with acute myeloid leukemia, but it also induces some adverse events. Although this therapy has a small impact on the quality of life, further attention is still needed to reduce the occurrence of such adverse events.

LOWER MORTALITY RISK WITH COMBINATION THERAPY WITH ANTI-TNF THERAPY AND THRIOPURINE COMPARED TO THIOPURINE ALONE IN ELDERLY PATIENTS WITH UC

Abstract INTRODUCTION Despite increasing incidence rates of ulcerative colitis (UC) in the elderly, efficacy and safety data for medical management in this cohort is lacking due to underrepresentation in clinical trials and registries. Selection of medical therapy is often complex, taking into consideration a multitude of factors, including real and perceived risks of infection and malignancy. In the past, immunomodulators, such as thiopurines, were commonly used as monotherapy for maintenance, offering the added advantages of affordability and oral administration. Indeed, there are elderly patients who have been maintained for decades on thiopurine monotherapy. Further, thiopurines can be used in combination with anti-TNF therapy for improved efficacy and reduced immunogenicity compared to monotherapy with either agent in ulcerative colitis (UC). Whether the use of combination therapy imposes an additive risk compared to thiopurine monotherapy is still unclear. This study aimed to investigate outcomes of thiopurine monotherapy versus combination therapy with anti-TNF agents in elderly patients (age ≥65 years) with UC. METHODS The TriNetX Research Network was accessed on October 15th, 2023, to compare outcomes in elderly patients 65 years or older with UC who are receiving thiopurine monotherapy and patients who are receiving combination therapy with an anti-TNF (adalimumab, certolizumab pegol, golimumab, or infliximab). The outcomes examined were 1-year rate of corticosteroid and colectomy as well as 10-year rate of mortality, colon cancer, skin cancer, and respiratory and urinary tract infections. Statistical risk analysis was performed using the TriNetX analytical platform. RESULTS A total of 2,597 patients (2,245 thiopurines monotherapy and 352 AZA plus anti-TNF combination therapy) were included in the study (Table 1). Among the monotherapy and combination therapy cohorts, mean age was 71 years old and approximately 56% male. Ten-year mortality was higher in the thiopurine monotherapy group (OR 1.67, p=0.002). The combination therapy cohort had higher rates of steroid use (32.4% vs. 24.3%, p=0.001) and colectomy at 1 year compared to the monotherapy cohort (4.5% vs. 1.2%, p<0.001). There was no significant difference in 10-year risk of colon cancer (OR 1.05, p=0.88), skin cancer (OR 1.51, p=0.06), incidence of respiratory (OR 1.48, p=0.07) and urinary tract infections (OR 1.18, p=0.23). CONCLUSION The study findings highlight the risks of thiopurine use in patients over the age of 65 given the significantly higher 10-year mortality risk in thiopurine monotherapy-treated patients. The results also suggest that combination therapy with thiopurine and anti-TNF therapies - despite utilization in patients with more active disease indicators - is not associated with an additive risk in terms of infection and mortality in elderly patients. Table 1 Characteristics and Outcomes of Elderly Patients with UC either on Thiopurine Monotherapy or Combination Therapy with anti-TNF agents

Myocardial bridge in a patient with castration-resistant metastatic prostate cancer treated with enzalutamide.

Myocardial bridge is a morphological anomaly of the heart characterised by the presence of a myocardial segment above a coronary artery, which results in a higher risk of cardiovascular events. In patients with prostate cancer treated with androgen receptor-targeted agents, a higher risk of cardiotoxicity was observed. An 88 years old man with metastatic castration-resistant prostate cancer in treatment with enzalutamide, denosumab, and triptorelin presented to our attention complaining dyspnoea and angina pectoris. Blood examinations revealed normal Troponin I levels. Transthoracic echocardiography revealed no signs of acute myocardial ischaemia. The treadmill stress test revealed S-T tract under levelling in V4-V6 with a very slow resolution. Coronary angiography identified a myocardial bridge in the medium tract of the interventricular anterior artery. Due to these findings, ranolazine and simvastatin were started and, after multidisciplinary assessment, we decided to continue the treatment with enzalutamide. At the first follow-up visit echocardiography found out the cardiological reports stability and no therapy changes were performed. During follow-up visit cardiological revaluation showed reports stability and no therapy changes were performed. Due to the high prevalence of prostate cancer in elderly patients at high cardiovascular risk and the increasing use of androgen receptor-targeted agent, a multidisciplinary approach is highly recommended to weigh survival benefits on toxicities. This case report may support the use of androgen receptor-targeted agent in elderly patients with controlled cardiovascular diseases, a population that is often excluded from randomised trials.

Efficacy and safety analysis of immune checkpoint inhibitors plus angiogenesis inhibitors for treatment of advanced driver-negative NSCLC in elderly patients: A retrospective study.

e21044 Background: Immune checkpoint inhibitors (ICIs) combined with antiangiogenic drugs may have synergistic effects in elderly patients with advanced driver-gene wild-type non-small cell lung cancer (NSCLC), but its true efficacy remains unclear. In addition, the chemotherapy tolerance of elderly NSCLC patients is poor, and the precise identification of the population who can benefit from ICIs combined with angiogenesis inhibitors is also the focus of current research. Methods: We retrospectively compared the clinical efficacy and safety of ICIs combined with or without antiangiogenic agents in elderly patients with advanced driver-gene negative NSCLC who were ≥65 years old in the Cancer Center of the Affiliated Suzhou Hospital of Nanjing Medical University. The primary endpoint was progression-free survival (PFS). The secondary endpoints were overall survival (OS), objective response rate (ORR), and immune-related adverse events (irAEs). Results: A total of 36 patients in the IA group（Immune checkpoint inhibitors plus angiogenesis inhibitors group) and 43 patients in the NIA group（Immune checkpoint inhibitors without angiogenesis inhibitors group) were enrolled in the study between January 1, 2019 and December 31, 2021. The median follow-up time for patients in IA group and NIA group was 18.2 months (95%CI: 14 - 22.5 months) and 21.4 months (95%CI: 16.7 -26.1 months), respectively. The median PFS and median OS were longer in the IA group compared to the NIA group（8.1 months vs 5.3 months；HR for PFS: 0.778, 95%CI: 0.474-1.276, P = 0.32; NA vs 30.9 months; HR for OS: 0.795, 95%CI: 0.396-1.595, P = 0.519). Subgroup analysis showed that patients in the IA group had significantly longer PFS in the subgroup with PD-L1 expression ≥50% (P = 0.017), and the relationship between treatment regimens and outcomes was still discrepant in different PD-L1 expression levels (P for interaction = 0.002). There was no significant difference in ORR between the two groups (23.3% vs 30.5%, P = 0.465). The incidence of adverse events in IA group was lower than that in NIA group (39.5% vs 19.4%, P = 0.05), and the cumulative incidence of treatment interruptions due to adverse events was significantly reduced (P = 0.045). Conclusions: In elderly patients with advanced driver-gene wild-type NSCLC, the addition of antiangiogenic agents to ICIs therapy did not provide significant clinical benefit, but the incidence of treatment interruptions due to adverse events was significantly reduced. In the subgroup analysis, we found that the clinical benefit of this combination therapy was observed in patients with PD-L1 expression ≥50%, which warrants further exploration. Clinical trial information: NCT05688046 .

Thyroid dysfunction and immune checkpoint inhibitors: Effect on survival in elderly patients.

e24020 Background: Aging inevitably leads to an accumulation of senescent cells, and immune system cells aren't an exception. They can contribute to a pro-inflammatory state and be involved in the immune escape of cancer cells through a boosted PD-L1 expression. Immunocheckpoint inhibitors (ICIs) represent the standard of care in several cancer histotypes, and immune-related adverse events (irAEs) seem to be associated with better outcomes. ICIs represent a valid therapeutic agent in elderly patients too. However, there is a lack of data on irAEs and outcomes correlation in this subgroup of patients. This retrospective-prospective study aims to evaluate the relationship between thyroid dysfunction and progression-free survival (PFS) and overall survival (OS) in elderly patients undergoing ICIs. Methods: From January 2019 to January 2023, we retrospectively collected data from 65 elderly patients under treatment with ICIs at the Medical Oncology Unit of the University Hospital and University of Cagliari, Italy. All patients were affected by stage IV disease. The primary endpoint was PFS and the secondary endpoint was overall survival OS. Statistical analyses were performed using the MedCalc Statistical Software Version 20.216. Results: The median age was 76 (± 5,5); 15.38% were female, whereas 84.62% were male. The histologies were: melanoma (26.9%), lung cancer (48.0%), kidney cancer (15.3%), and colorectal cancer (9.8%). Compared to those without thyroid dysfunction during immunotherapy treatment, individuals with thyroid irAE had, at univariate analysis, longer median PFS (68 versus 26 months, p = 0.02, CI 95% 18.0-68.0, HR 0.29 0.10-0.83) and longer median OS (59 versus 39 months, p = 0.04, CI 95% 25.0-90.0 HR 0.50 0.25-0.99). Conclusions: In an era where biomarkers for immunotherapeutic agents are lacking, thyroid dysfunction irAE could be a predictive factor of better PFS and OS in elderly patients affected by cancer of various histology.

Impact of comorbidities in elderly and frail patients and response to biological therapy in psoriasis.

Impact of comorbidities in elderly and frail patients and response to biological therapy in psoriasis.

A Systematic Review on the Duration of Antipsychotic Exposure and the Risk of Cerebrovascular Events in Elderly Patients (P11-5.020)

<h3>Objective:</h3> To evaluate the impact of duration of exposure to antipsychotic medications on the risk of cerebrovascular events (CVE) in elderly patients. <h3>Background:</h3> The FDA issued black box warnings for typical (1st generation) and atypical (2nd generation) antipsychotic medications (APM) regarding an increased risk of stroke and death in elderly patients with dementia. Several studies have compared the cerebrovascular risk profiles of typical and atypical antipsychotic agents in elderly patients, but the influence of duration of antipsychotic exposure on this risk remains unclear. <h3>Design/Methods:</h3> A comprehensive literature search was performed on PubMed in June 2022, the results of which were systematically screened using predefined inclusion and exclusion criteria. Included articles adequately controlled for confounding variables and reported on the duration of continuous exposure to APM and the risk of CVE in patients over 65. Quality assessment of the included studies was performed using the Newcastle-Ottawa scoring system. <h3>Results:</h3> From the 7,515 articles generated by the search, five observational studies reporting on APM duration and CVE in elderly patients were selected based on quality as they satisfied the inclusion criteria. Four studies found that long-term (&gt; 90 days), but not short-term, use of typical APM conferred a greater CVE risk than atypical APM used for the same duration. One study including only patients with dementia did not identify a difference with short or long-term use of typical versus atypical APM. <h3>Conclusions:</h3> The duration of therapy with APM may influence the risk of CVE in elderly patients. Although atypical agents are associated with the development of metabolic syndrome, long-term use of typical APM may confer a greater risk of CVE than atypical APM. Differences in the risk of CVE are less salient in short-term use of APM. <b>Disclosure:</b> Mr. Devine has nothing to disclose. Dr. Memon has nothing to disclose.

Efficacy and Safety Analysis of Immune Checkpoint Inhibitors plus Angiogenesis Inhibitors for the Treatment of Advanced Driver-negative NSCLC in Elderly Patients: A Retrospective Study.

Background and Objective: Immune checkpoint inhibitors (ICIs) combined with angiogenesis inhibitors may have synergistic effects in elderly patients with advanced driver-negative NSCLC, but its true efficacy remains unclear. In addition, chemotherapy tolerance in elderly NSCLC patients is poor, and the precise identification of the population that may benefit from ICIs combined with angiogenesis inhibitors is also the focus of current research. Methods: We retrospectively compared the efficacy and safety of ICIs combined with or without antiangiogenic agents in elderly patients with advanced driver-gene negative NSCLC ≥65 years of age in the Cancer Center of Suzhou Hospital Affiliated to Nanjing Medical University. The primary endpoint was PFS. Secondary endpoints were OS, ORR, and immune-related adverse events (irAEs). Results: A total of 36 patients in the IA group (immune checkpoint inhibitors plus angiogenesis inhibitors group) and 43 patients in the NIA group (immune checkpoint inhibitors without angiogenesis inhibitors group) were enrolled in the study between January 1, 2019 and December 31, 2021. The median follow-up time for patients in the IA group and NIA group was 18.2 months (95%CI: 14 - 22.5 months) and 21.4 months (95%CI: 16.7 -26.1 months), respectively. The median PFS and median OS were longer in the IA group compared to the NIA group (8.1 months vs 5.3 months; HR for PFS: 0.778, 95%CI: 0.474-1.276, P=0.32; NA vs 30.9 months; HR for OS: 0.795, 95%CI: 0.396-1.595, P=0.519). There were no significant differences in median PFS and median OS between the two groups. Subgroup analysis showed that patients in the IA group had significantly longer PFS in the subgroup with PD-L1 expression ≥50% (P=0.017), and the association between different groups and disease progression was still different in the two subgroups (P for interaction = 0.002). There was no significant difference in ORR between the two groups (23.3% vs 30.5%, P=0.465). The incidence of irAEs in the IA group was lower than that in the NIA group (39.5% vs 19.4%, P=0.05), and the cumulative incidence of treatment interruptions due to irAEs was significantly reduced (P=0.045). Conclusion: In elderly patients with advanced driver-negative NSCLC, the addition of antiangiogenic agents to ICIs therapy did not provide significant clinical benefit, but the incidence of irAEs and treatment interruptions due to irAEs was significantly reduced. In the subgroup analysis, we found that the clinical benefit of this combination therapy was observed in patients with PD-L1 expression ≥50%, which warrants further exploration.

P451 Evaluating drug sustainability, efficacy and safety of biologic agents in elderly patients with Inflammatory Bowel Disease: a single center retrospective study

Abstract Background Despite the advancement in pharmacological management of Inflammatory Bowel Disease (IBD), the efficacy and the side effects of the biologics are rarely studied in the elderly population. Our aim was to evaluate retrospectively the drug sustainability, efficacy, and safety of the biologic therapies in the elderly IBD population. Methods Consecutive elderly (&amp;gt; 60 years old) IBD patients, treated with biologics (infliximab, adalimumab, vedolizumab, ustekinumab) followed at the McGill University IBD Center were included between January 2000 and 2020. The efficacy of treatment was measured using clinical and biochemical parameters. Response and remission variables were measured at three distinct time points from the start date of the biologic agent, as in 3, 6–9 and 12–18 months. Patients required a minimal follow-up period of three months. Adverse events (AE) or serious adverse events (SAE) occurring within three months of the last biologic dose were considered to be related to the biologic agent. Results We identified a total of 147 elderly patients with IBD treated with biologic agents (109 Crohn’s disease (CD) and 38 ulcerative colitis (UC)). Disease location was predominantly ileocolonic (47.7%) in CD and pancolitis(63.2%) in UC. 47.6% of elderly IBD patients had attempted at least 1 biologic agent (Table1). The mean duration of biologic treatment was 157.5 (SD:148)weeks. Steroid exposure varied from 34% at the start of biologic therapy to 19% at 3 months, 16.3% at 6–9 months and 6.5% at 12–18 months.’ The remission rates at 3, 6–9 and 12–18 month were not significant between the biologic therapies. Kaplan-Meyer analysis did not show statistical difference for drug sustainability (p=0.195)(Figure1), time to adverse event (p=0.158) (Figure2) or infection rates (p=0.973) (Figure3) between all four biologics studied. The most common AEs led to discontinuation were loss of response, infusion or injection reaction and infection. Conclusion Current biologic therapies were not different with regards to drug sustainability and safety in the elderly IBD population. Based on these results, we are not able to suggest a preferred sequencing order among biologicals.

Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study

BackgroundRemimazolam, a novel benzodiazepine, has been reported to cause less hypotension than propofol during induction of anesthesia. Therefore, remimazolam might be a valuable option in elderly patients with severe aortic stenosis who are considered to be the most vulnerable to hemodynamic instability. We aimed to evaluate the feasibility and hemodynamic effects of remimazolam as an induction agent in elderly patients with severe aortic stenosis.MethodsThis prospective, open-label, single-arm, observational pilot study was conducted in a university hospital between November 2020 and April 2021. We included 20 patients aged 65 years or older scheduled for transcatheter or surgical aortic valve replacement for severe aortic stenosis under general anesthesia. Patients were administered intravenous remimazolam infusion at 6 mg/kg/h combined with 0.25 μg/kg/min of remifentanil infusion. The primary outcome was the vasopressor dosage between the induction of anesthesia and the completion of tracheal intubation. The secondary outcomes included hemodynamic changes, bispectral index changes, and the time from the start of remimazolam infusion to loss of consciousness. We also recorded awareness during anesthesia induction and serious adverse events related to death, life-threatening events, prolonged hospitalizations, and disability due to permanent damage.ResultsTwenty patients aged 84 [79–86] (median [interquartile range]) with American Society of Anesthesiologists physical status 4 were analyzed. Ephedrine 0 [0–4] mg and phenylephrine 0.1 [0–0.1] mg were administered to 14/20 patients (3 doses in 1 patient, 2 doses in 4 patients, and one dose in 9 patients). Loss of consciousness was achieved at 80 [69–86] s after the remimazolam infusion was started. The mean arterial pressure decreased gradually after loss of consciousness but recovered immediately after tracheal intubation. The bispectral index values gradually decreased and reached < 60 at 120 s after loss of consciousness. Neither awareness during induction of anesthesia nor serious adverse events, such as severe bradycardia (< 40 bpm), life-threatening arrhythmia, myocardial ischemia, or anaphylactic reactions were observed.ConclusionsRemimazolam could be used as an induction agent with timely bolus vasopressors in elderly patients with severe aortic stenosis.Trial registrationUMIN Clinical Trials Registry, identifier UMIN000042318.

Abstract 14109: Ischemic and Bleeding Outcomes of Potent P2y12 Inhibitor Antiplatelet Agents versus Clopidogrel in Elderly Patients With Acute Coronary Syndrome: A Meta-Analysis of Randomized Trials

Introduction: Potent oral P2Y12 inhibitors (prasugrel or ticagrelor) are recommended in patients who present with acute coronary syndrome (ACS) compared to clopidogrel on the basis of landmark trials. However, there is no clear recommendation for such agents in elderly patients (&gt;65 years) with ACS. Methods: We queried the electronic databases of PubMed, Cochrane Central Register of Clinical Trials, EMBASE and ClinicalTrial.gov since inception through February 25, 2021 for randomized studies evaluating potent oral P2Y12 inhibitors vs. clopidogrel in elderly patients who present with ACS. Hazard ratios (HR) with 95% confidence interval (CI) were computed and p&lt;0.05 was considered statistically significant. Results: Eight randomized studies including a total of 10,081 patients were included in this analysis. At mean follow-up of 26 months, there was no significant difference between potent oral P2Y12 inhibitors and clopidogrel in terms of MACE [HR 0.97, 95% CI 0.82-1.15; P 0.73] (Figure), all-cause mortality [HR 0.91, 95% CI; 0.75-1.10: P 1.00], myocardial infarction [HR 0.95, 95% CI; 0.78-1.17: P 0.64], and stroke [HR 1.24, 95% CI; 0.82-1.86: P 0.31]. There was significant increase in major bleeding with potent oral P2Y12 inhibitors in elderly compared to clopidogrel [HR 1.32, 95% CI; 1.09-1.59: P 0.004](Figure) while the cardiovascular mortality was significantly decreased in the elderly treated with potent oral P2Y12 inhibitors compared to clopidogrel [HR 0.82, 95% CI; 0.68-0.98: P 0.03]. Conclusions: This meta-analysis suggests that using potent oral P2Y12 inhibitors in elderly patients with ACS is associated with a reduction in the risk of cardiovascular mortality with increased risk of bleeding compared to clopidogrel with no significant change in terms of MACE.

Toxicity and antitumor activity of novel agents in elderly patients with cancer included in phase 1 studies.

IntroductionThe number of cancer cases among the elderly continue to increase as the worldwide population ages. This patient subset is underrepresented in clinical trials, partly because of unresolved uncertainties about age-associated tolerabilities and antitumor activities. We reviewed phase 1 trial data to study tolerance and efficacy of novel agents used for treatment of elderly patients with cancer.MethodsData from 773 consecutive evaluable patients in 85 phase 1 clinical trials (2008-2016) at START Madrid-CIOCC were analyzed according to age, with respect to objective response, survival, and toxicity.ResultsThe mean age was 58.7 (range: 18-87) years; 260 (33.6%) patients were >65 y (elderly group). One hundred thirty-seven (17.8%) patients received immunotherapy drugs, 308 (39.8%) received targeted agents, and 328 (42.4%) received chemotherapy. No statistically significant differences in overall survival, objective response, or severe toxicity rates were found according to treatment type. Similar toxicities and clinical activities were found between the two age subgroups; 18.8% of the elderly and 20.7% of the younger patients experienced severe hematological toxicity (p=0.5), and 30.2% and 32.7%, respectively, experienced severe non-hematological toxicity (p=0.4). Regarding antitumor activity, 12.4% of the elderly and 15% of the younger patients achieved objective responses (p=0.41). There were no significant between-group differences in overall survival (9.7 versus 11.5 months, respectively, p=0.1) or progression-free survival (2.3 versus 2.2 months, respectively, p=0.7).ConclusionsThis retrospective study found that elderly and younger populations had comparable antitumor activities and toxicity profiles. These results support including elderly patients with cancer in early-phase trials.

Effect of anti-coagulation in elderly patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation has been shown to associate with greater cognitive decline and increased dementia risk independent of ischaemic stroke. Anti-coagulation was associated with a lower risk of ischemic stroke and positive net clinical benefit in elderly patients in Asian populations. We hypothesise that elderly patients (&amp;gt;75 years old) with atrial fibrillation on oral anti-coagulants have lower incidence of dementia compared with patients on anti-platelet agents or no anti-thrombotic treatment. Method A retrospective study of 747 patients, male 37%, mean age 84.29 ± 5.99 years old with mean follow up of 13.54 ± 3.38 years. 94 % hypertension, 40% diabetes mellitus, 38% ischaemic heart disease, 33% heart failure, 39% previous stroke, mean CHA2DS2-VASc score of 5.23 ± 1.59. 27% patients on oral anti-coagulants, 64% anti-platelet agent and 9% not on any anti-thrombotic medication. Results 265 patients were diagnosed with dementia, 17 patients were on oral anti-coagulants, 222 patients were on anti-platelet agent. Oral anti-coagulants were associated with lower incidence of dementia compared with anti-platelet agents (p &amp;lt; 0.0001). 26 patients developed dementia were not on any anti-thrombotic agent. 261 patients were readmitted with stroke (2.58%/100 patient year) 182 patients were on anti-platelet agent while 12 were on anti-coagulant (P &amp;lt; 0.0001). Conclusions Oral anti-coagulants were associated with lower incidence of dementia and stroke compared with anti-platelet agents in elderly patients with atrial fibrillation.

Prevention of stroke and dementia in elderly patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation has been shown to associate with greater cognitive decline and increased dementia risk independent of ischaemic stroke. Anti-coagulation was associated with a lower risk of ischemic stroke and positive net clinical benefit in elderly patients. We hypothesise that elderly patients (&amp;gt;75 years old) with atrial fibrillation on oral anti-coagulants have lower incidence of dementia compared with patients on anti-platelet agents or no anti-thrombotic treatment. Method A retrospective study of 747 patients, male 37%, mean age 84.29 ± 5.99 years old with mean follow up of 13.54 ± 3.38 years. 94 % hypertension, 40% diabetes mellitus, 38% ischaemic heart disease, 33% heart failure, 39% previous stroke, mean CHA2DS2-VASc score of 5.23 ± 1.59. 27% patients on oral anti-coagulants, 64% anti-platelet agent and 9% not on any anti-thrombotic medication. Results 265 patients were diagnosed with dementia, 17 patients were on oral anti-coagulants, 222 patients were on anti-platelet agent. Oral anti-coagulants were associated with lower incidence of dementia compared with anti-platelet agents (p &amp;lt; 0.0001). 26 patients developed dementia were not on any anti-thrombotic agent. 261 patients were readmitted with stroke (2.58%/100 patient year) 182 patients were on anti-platelet agent while 12 were on anti-coagulant (P &amp;lt; 0.0001). Conclusions Oral anti-coagulants were associated with lower incidence of dementia and stroke compared with anti-platelet agents in elderly patients with atrial fibrillation.

Pharmacological Treatment of Osteoporosis in Elderly People: A Systematic Review and Meta-Analysis

Background: The evidence supporting the use of antiresorptive and anabolic agents for fracture prevention in elderly patients is still inconclusive. Whether it is too late to alter the course of the disease in this age-group has remained uncertain. Objectives: The objective of this study was to determine the efficacy and safety of antiresorptive and anabolic agents in elderly patients. Methods: PubMed, Web of Science, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) and post hoc analyses of RCTs reporting efficacy outcomes or adverse events of antiresorptive and anabolic agents in elderly patients. Statistical heterogeneity was assessed with the Cochran Q χ² test and I² statistic. All results were expressed as relative risk (RR) with 95% confidence intervals (CIs). Results: The meta-analysis included 1 RCT and 11 post hoc analyses of data from 10 double-blind placebo-controlled RCTs. Antiresorptive therapy significantly reduced the pooled incidence of vertebral fractures (RR = 0.43; 95% CI = 0.35–0.53; and p < 0.001). It was also associated with lower risk of nonvertebral and hip fractures (RR = 0.84; 95% CI = 0.74–0.96; and p = 0.009 and RR = 0.75; 95% CI = 0.58–0.97; and p = 0.028, respectively). For any adverse events, no difference was observed between antiresorptive agents and placebo groups (RR = 1.01; 95% CI = 1.00–1.02; and p = 0.23). Conclusions: Both antiresorptive and anabolic agents represented potentially important osteoporosis treatments, showing significant effects on reducing vertebral, nonvertebral, or hip fracture risk, and were well-tolerated by elderly patients. Even in the elderly, maybe it is not too late to alter the course of the disease.

Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty

Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic.&#x0D; Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement.&#x0D; Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups.&#x0D; Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups.&#x0D; Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.

Biologic Treatment in Elderly Patients With Psoriasis: A Systematic Review.

With our aging population, an increasing number of psoriasis patients are classified as elderly. However, psoriasis treatment in older adults can be challenging, given an increased number of comorbid conditions and immunosenescence. Biologic agents present a solution to this treatment dilemma because of their high efficacy and favorable tolerability. The objective of this systematic review was to summarize the findings of clinical trial and real-world studies exploring the safety and efficacy of biologic agents in elderly patients with moderate-to-severe psoriasis. We searched MEDLINE, Embase, the Cochrane Library, and clinical trial databases. Studies analyzing biologics for psoriasis were included if elderly patients were the main population of interest or were a separate subgroup in their analysis. Eighteen articles met inclusion criteria after screening. Across all biologic classes, efficacy for biologics between nonelderly adult patient and elderly patients was similar. Adverse events (AEs) and infections occured at a similar frequency between both groups. However, serious AEs were more common in the elderly. The available literature on the safety and efficacy of biologic agents in elderly patients supports the use of these agents in this population. However, serious AEs and discontinuation due to AEs were more common in older patients. As elderly patients have a higher burden of comorbid conditions and an increased baseline vulnerability for AE, physicians should continue to be prudent in screening before initiating biologics and monitor patients more closely as AEs tend to be more severe.

Comparative Effectiveness of Chemotherapy, Rituximab, and Bendamustine in Medicare Beneficiaries With Mantle-Cell Lymphoma

BackgroundOver the past 2 decades, rituximab, bortezomib, and bendamustine have been approved to treat mantle-cell lymphoma (MCL). To date, few studies have evaluated the comparative effectiveness of these novel agents. Therefore, this study evaluated the comparative effectiveness of those novel agents in elderly patients newly diagnosed with MCL. Patients and MethodsAll newly diagnosed MCL patients aged 66 or older were identified from Surveillance, Epidemiology, and End Results Program (SEER)-Medicare databases from 1999 to 2013. Patients were categorized into 4 groups on the basis of their first-line treatment regimens: chemotherapy alone, rituximab ± chemotherapy, bortezomib ± chemotherapy, and bendamustine ± chemotherapy. Multivariable proportional hazard regressions with 1-year follow-up from treatment were performed to compare the all-cause, MCL-specific, and noncancer mortality rates. Sensitivity analyses using propensity score–adjusted and instrumental variable–adjusted regressions were also conducted. ResultsA total of 1215 MCL patients were included. The bortezomib group was not included in the primary analyses because of the small sample size (n = 24). On multivariable analyses, the rituximab group showed significant decrease in both 1-year all-cause mortality (hazard ratio [HR] = 0.38, 95% confidence interval [CI], 0.25-0.59) and MCL-specific mortality (HR = 0.38; 95% CI, 0.24-0.60) compared to the chemotherapy-alone group. The bendamustine group showed significant decrease in 1-year MCL-specific mortality (HR = 0.49; 95% CI, 0.24-0.99) compared to the chemotherapy-alone group. The results from sensitivity analyses were similar to those from primary analyses. ConclusionFor elderly patients with newly diagnosed MCL, rituximab-based regimen and bendamustine-based regimen as first-line treatment significantly decreased 1-year mortality rates compared to chemotherapy alone.