Frailty is associated with increased risk of hospital admission in patients with Crohn’s disease treated with anti-TNF therapy

Objective Management of older people with inflammatory bowel diseases can be complicated by comorbidities, polypharmacy and increased risk of adverse events. We aim to examine whether frailty is associated with an increased risk of hospital admission in patients with Crohn’s disease treated with antitumour necrosis factor (TNF) therapy. Design/method Post hoc analysis of the Personalised Anti-TNF Therapy in Crohn’s Disease study was conducted. Adult, biological naïve patients with active luminal Crohn’s disease were followed-up after initiation of infliximab or adalimumab. A frailty index (FI) was constructed using variables collected at study entry. Survival analysis using Cox proportional hazards was performed to evaluate effects of frailty on risk of hospital admissions. Results Of 1285 patients included, 792 (61.6%) patients had sufficient baseline data for FI calculation. 536 (67.7%), 77 (9.7%) and 179 (22.6%) patients were defined as ‘fit’, ‘prefrail’ and ‘frail,’ respectively. On multivariable analysis, baseline characteristics associated with all-cause hospital admission included anaemia (HR 1.49 (1.09–2.05, p=0.013)) and inability to perform usual activities (HR 2.54 (1.43–4.49, p=0.001)). After adjusting for age and sex, frailty was associated with an increased risk of all-cause hospital admission (HR 1.93 (1.40–2.67, p<0.001)) and non-Crohn’s-related hospital admission (HR 2.74 (1.63–4.63, p<0.001)). Conclusion We demonstrate in patients with Crohn’s disease, treated with anti-TNF medication, that frailty is associated with higher risk of all-cause and non-Crohn’s-related hospital admission.