Steroids associated with shortened life expectancy in older adult IBD
Click Here to Manage Email Alerts
Mesalamine correlated with the longest life expectancy among older adult patients with inflammatory bowel disease, while steroid use correlated with the shortest life expectancy, according to research published in BMC Gastroenterology.
“Life expectancy reframes mortality in a way that is more accessible to patients: the number of years they can expect to live rather than the relative risk of death. We previously demonstrated that life expectancy among people with IBD has increased since the introduction of biologic therapy; this study takes these findings one step further focusing on the association between IBD medications and life expectancy in seniors with IBD,” M. Ellen Kuenzig, PhD, senior research associate at SickKids Inflammatory Bowel Disease Center, told Healio. “This is particularly important since IBD is becoming increasingly common among seniors and managing seniors is more complex than managing IBD in younger individuals due to age-related comorbidities such as cardiovascular disease and diabetes as well as many IBD-related medications being linked to higher rates of infection and malignancy.”
In a retrospective cohort study, researchers compared the life expectancy of 28,260 patients with IBD aged 65 years or older who received either immunomodulator monotherapy, biologic monotherapy, combination therapy, mesalamine, systemic steroids or no therapy. Stratified by sex, they generated mortality rates using a period life table approach.
According to study results, life expectancy at 65 years was longest among patients taking mesalamine and shortest among patients taking steroids regardless of sex (women: 22.1 years; 95% CI, 21.8-22.5 vs. 11.7 years; 95% CI, 11-12.4; men: 19.6 years; 95% CI, 19.3-20 vs. 10.3 years; 95% CI, 9.7-10.8). While Kuenzig and colleagues noted no significant difference in life expectancy among patients who received either immunomodulatory monotherapy or biologic monotherapy, immunomodulator monotherapy correlated with a decreased life expectancy compared with combination therapy by 5.1 years (95% CI, 2.3-7.8) for women and 2.8 years (95% CI, 0.1-5.5) for men.
They observed the lowest age-standardized mortality rate among women who received combination therapy with a biologic and immunomodulator (20.4 deaths/1,000 person-years [PY]; 95% CI, 11.3-34) followed by women who received mesalamine (33.1 deaths/1,000 PY; 95% CI, 30.8-35.5) and for men who received mesalamine (35.8 deaths/1,000 PY; 95% CI, 33.4-38.3) followed by men in the no-therapy group (45.2 deaths/1,000 PY; 95% CI, 43.3-47.2) and combination therapy (45.4 deaths/1,000 PY; 95% CI, 21.8-83.5). For both patient groups, the highest mortality rates occurred among those who received systemic steroids (women: 100.4 deaths/1,000 PY; 95% CI, 92.3-109; men: 125 deaths/1,000 PY; 95% CI, 114.8-136).
“Life expectancy in seniors with IBD varies across medication groups with patients on mesalamine having the longest life expectancy and patients on steroids having the shortest life expectancy. The similarities in the life expectancy observed among people on immunomodulators and biologics, both likely prescribed to those with moderate to severe disease, and patients not on any therapy, suggest that well-controlled disease is an important predictor of life expectancy in seniors with IBD and should be balanced with the potential complications of therapy when deciding on a disease-management strategy,” Kuenzig said. “Future research should focus on the role factors [IBD severity, phenotype or individual patient comorbidities] play and the interaction between them in influencing life expectancy.”
Editor’s note: This story was updated Jan. 6, 2022, to include original comment from a study author as well as to better reflect key findings in the headline.
Perspective
Back to Top
Jessica Philpott, MD, PhD
This study is welcomed in providing additional evidential support for the goal of steroid-free remission and understanding how our current treatment strategies are meeting a key goal of improving life expectancy in patients older than 65 years. These data would suggest that even in older adults, standard treatment with use of biologics, dual therapy, immunomodulators and mesalamine yields relatively similar life expectancy and that patients on steroids suffer significantly lower life expectancy.
There are several aspects of this study that limit the applicability and should encourage further research in this area. Most obviously, the time period of 1997 to 2017 captures an era during which dramatic shifts in IBD therapy were occurring and only midway through was biologic use widespread. Another important limit to this health administrative data is that disease phenotype and severity are not available as part of the analysis. This may have a significant impact on possible outcomes. While medication use may be suspected as a surrogate for disease severity, there are many additional variables involved in selection of therapy for IBD patients that impact prognosis. When we look at the data regarding corticosteroid use, a concern would be that this usage represents other variables, such as lack of access to IBD specialist care, lack of compliance, medically refractory disease or chronic conditions that present obstacles to the use of biologics in diseases such as heart failure or cancer.
There are several takeaways from this study. This is part of an important body of work by this group contributing efforts to understand how best to manage IBD therapy to impact a vital outcome — life-expectancy. Studies have shown that older patients are less likely to receive biologic therapy. These data certainly support use of biologics and immunomodulators in patients older than 65, along with aggressive avoidance of corticosteroids.
Collapse
Click Here to Manage Email Alerts