Older IBD patients less often treated with biologics, immunomodulators

Patients diagnosed with inflammatory bowel disease at age 60 years or older were more likely to receive treatment with corticosteroids rather than biologics or immunomodulators compared with those diagnosed at a younger age, according to new research published in Gastroenterology.

Older IBD patients also showed a higher absolute risk for bowel surgery compared with the general population, “but in relative terms, the risk increase was larger in younger age groups,” investigators wrote.

They noted that IBD diagnoses are increasing among elderly individuals, although IBD onset is most common between 20 and 30 years, and prior research suggests onset after age 60 is uncommon and less severe.

“We therefore sought to ascertain the incidence of inflammatory bowel disease in older age groups and if there is any difference in how they are treated and how they use the healthcare services,” Åsa Hallqvist Everhov, MD, researcher at Karolinska Institutet’s department of clinical research and education, and colorectal surgeon at Stockholm South General Hospital, said in a press release.

Hallqvist Everhov and colleagues performed a national population-based registry study, identifying all incident IBD cases in Sweden between 2006 and 2013 (n = 27,834), and up to 10 matched individuals from the general population for comparison.

They found that 23% of these IBD patients received diagnosis at age 60 years or older (median age, 69 years), and during a median follow-up period of 4.2 years, they used more health care resources and had more IBD-related hospitalizations than younger adults with IBD. They were also more likely to undergo surgery (13% vs. 10% after 5 years; P < .001), and required it sooner than younger adult patients, often within the first year of disease onset.

“It’s common, in other words, for the disease to onset after the age of 60 and we found no evidence that when it does, the disease progress is milder,” Hallqvist Everhov said in the press release.

Notably, older IBD patients were less likely to receive immunomodulators or biologic therapy than younger patients, and were more likely to receive systemic corticosteroids.

After 5 years of diagnosis, 2% of older patients with ulcerative colitis used biologics vs. 7% of younger adults and 10% of pediatric patients, and 6% of older patients with Crohn’s disease used them vs. 20% of adults and 23% of children.

During the same period, 33% of older Crohn’s patients vs. 54% of younger adult patients used immunomodulators, as did 17% of older UC patients vs. 28% of younger adult patients.

Older Crohn’s patients showed slightly lower use of systemic corticosteroids than their younger adult counterparts, but older UC patients showed a slightly higher use.

“We don’t know the reason for this, but it could be due either to under-prescription to older sufferers or to prudent choice, since the newer drugs carry certain risks and side-effects,” Hallqvist Everhov said in the press release. “Older patients often already have other potent drugs.”

She and colleagues concluded that their study “does not support the notion that elderly onset IBD has a milder clinical course than younger onset,” and they plan to further study the differences in treatment between older and younger patients. – by Adam Leitenberger

Disclosures: The authors report no relevant financial disclosures.