Lifelong immunosuppression is a cornerstone of management of immune-mediated inflammatory diseases (IMD). Older patients represent an increasingly large number of patients with these diseases but are particularly vulnerable to safety risks with therapy, particularly that of infection and malignancy. We performed this systematic review and meta-analysis to calculate the pooled safety of biologic therapy in older patients with IMD when compared to similar patients on non-biologic therapies or younger biologic users.