Older IBD Patients Use Fewer Biologics, More Corticosteroids

Compared with a diagnosis at a younger age, a diagnosis of inflammatory bowel disease (IBD) at age 60 years or older is associated with decreased use of biologics and immunomodulators, as well as a higher risk for bowel surgery, according to a recent study.

From 2006 to 2013, the researchers identified 27,834 Swedish individuals who had been diagnosed with incident IBD, along with up to 10 matched population comparator subjects. Median follow-up lasted 4.2 years.
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Patient data on were obtained via national registers. Diagnoses were categorized as pediatric (younger than 18 years), adult (18 to 59 years), or elderly (60 years or older).

Findings indicated that 6443 (23%) participants had received their first diagnosis of IBD at age 60 years or older, which corresponded to an incidence rate of 35 per 100,000 person-years. Of these, the researchers calculated an incidence rate of 10 per 100,000 person-years for Crohn disease, 19 per 100,000 person-years for ulcerative colitis, and 5 per 100,000 person-years for unclassified IBD.

Ultimately, the researchers found that an IBD diagnosis in elderly patients was associated with decreased rates of IBD-specific outpatient health care and increased rates of IBD-related hospitalizations and overall use of health care, compared with adult patients. Elderly patients also used fewer biologics and immunomudulators but used more systemic corticosteroids, compared with pediatric and adult patients.

Although the rate of extra-intestinal manifestations was similar in elderly and adult patients, bowel surgery was more common in elderly patients (13% after 5 years) vs adult patients (10% after 5 years). However, in relative terms, the absolute risk for bowel surgery was higher in younger age groups.

“The large differences in pharmacological treatment of adults and elderly patients are not necessarily due to a milder course of disease and warrant further investigation,” the researchers concluded.

—Christina Vogt

Reference:

Everhov ÅH, Halfvarson J, Myrelid P, et al. Incidence and treatment of patients diagnosed with inflammatory bowel diseases at 60 years or older in Sweden [Published online November 1, 2017]. Gastroenterology. http://dx.doi.org/10.1053/j.gastro.2017.10.034.