S1575 Comparative Risk of Infection-Related Hospitalization With Infliximab, Vedolizumab, and Ustekinumab in Elderly Inflammatory Bowel Disease: A Propensity-Score–Matched

Introduction: Managing inflammatory bowel disease (IBD) in older adults is challenging, as immunosenescence and comorbidities elevate the risk of serious infections. Although tumor necrosis factor-α antagonists (e.g., infliximab) remain a mainstay of therapy, newer gut-targeted agents such as vedolizumab and ustekinumab may offer improved safety in this vulnerable population. Yet, real-world, head-to-head data on infection-related hospitalization among elderly IBD patients are limited. This study therefore leveraged the global TriNetX Collaborative Network to compare 6-month hospitalization risks across these 3 biologic classes in patients aged ≥60 years. Methods: This retrospective cohort study utilized data from the global TriNetX Collaborative Network to identify patients aged ≥60 years with inflammatory bowel disease who newly initiated infliximab, vedolizumab, or ustekinumab between January 1, 2015, and December 31, 2024. The primary outcome was infection-related hospitalization within 6 months of treatment initiation. Three comparisons were performed: vedolizumab vs infliximab, ustekinumab vs infliximab, and vedolizumab vs ustekinumab. Propensity-score matching was used to balance baseline characteristics across treatment groups. We calculated univariable risk ratios with 95% confidence intervals to compare hospitalization risk in each matched cohort. Results: In propensity‐score–matched cohorts, infection‐related hospitalization was significantly lower with both vedolizumab and ustekinumab compared with infliximab, but did not differ between vedolizumab and ustekinumab. Specifically, among 3,283 matched patients per arm, vedolizumab was associated with a 10.97% hospitalization rate vs 15.90% for infliximab (RR 0.69, 95% CI 0.61–0.78; P < 0.0001). Similarly, in 2,918 patients per arm, ustekinumab yielded a 9.70% rate vs 13.88% with infliximab (RR 0.70, 95% CI 0.61-0.78; P < 0.0001). In the head‐to‐head comparison of vedolizumab (n = 2,497) and ustekinumab (n = 2,497), hospitalization occurred in 10.77% vs 9.49%, respectively (RR 1.14, 95% CI 0.96–1.34; P = 0.13). Conclusion: vedolizumab and ustekinumab were each associated with significantly lower hazards of key infection‐related hospitalizations—particularly lower respiratory and urinary tract infections, C. difficile enterocolitis, and all‐cause mortality—compared with infliximab in patients ≥60 years.