Colon to Rectum
Aliment Pharmacol Ther. 2023;58(1):48–59
Patients with elderly onset inflammatory bowel disease have a decreased chance of initiation of all types of medications and increased risk of surgeries – A nationwide cohort study
Objective: In patients with elderly (≥ 60 years) onset inflammatory bowel disease (IBD), the authors studied initiation of medications, drug persistency and surgeries.
Design: A nationwide cohort study based on Danish registries, comprising incident IBD patients ≥ 18 years from 1995 to 2020 (n = 69,039). Patients were divided into elderly (n = 19,187) and adult onset (n = 49,852). Outcomes were initiation of thiopurines, 5-aminosalicylic acid (5-ASA), biologics and corticosteroids within 1 and 5 years after diagnosis, and for those who initiated medications, drug persistency was estimated. Surgeries were examined within 1 and 5 years. Regression models controlling for covariates were used.
Results: In elderly patients, the adjusted hazard ratios (aHRs) for initiating thiopurines, 5-ASA and biologics within 1 year were 0.44 (95% confidence interval [CI]: 0.42–0.47), 0.77 (95% CI: 0.75–0.79) and 0.29 (95% CI: 0.26–0.31), respectively. The results were similar within 5 years. In elderly patients, drug persistency for thiopurines, 5-ASA and biologics was not impaired within 5 years. The aHRs of stopping steroids within 1 and 5 years were 0.80 (95% CI: 0.76–0.84) and 0.77 (95% CI: 0.74–0.80), respectively. The risk of surgeries was increased in the elderly patients (in ulcerative colitis, within 5 years, aHR = 1.39 [95% CI: 1.27–1.52], and in Crohn’s disease, aHR = 1.13 [95% CI: 1.04–1.23]).
Conclusion: The authors found significantly low chance of initiation of inflammatory bowel disease (IBD) medications in elderly patients; the reason may not be due to mild disease course. In elderly patients, drug persistency was comparable to adults. Clinicians should carefully consider whether they underuse IBD-specific medications in elderly patients, and special attention should be applied to timely discontinuation of corticosteroids.
DOI: 10.1111/apt.17520