Older IBD patients at disadvantage for medications, surgery

29 Apr 2023
Older IBD patients at disadvantage for medications, surgery

Older patients with inflammatory bowel disease (IBD) are less likely to be initiated on medications and are often scheduled for surgeries, a study has found.

The nationwide cohort study was based on Danish registries and included 69,039 adults with incident IBD diagnoses. Researchers looked at the frequency of initiation of thiopurines, 5-ASA, biologics, and corticosteroids within 1 and 5 years after diagnosis. They also estimated drug persistency for those who initiated medications and determined the surgeries performed within 1 and 5 years of IBD diagnosis.

Of the participants, 19,187 were ≥60 years of age (older-onset IBD) and 49,852 were 18–59 years of age (adult-onset IBD). In the older-onset IBD group, 13,758 (71.7 percent) participants had ulcerative colitis and 5,429 (28.3 percent) had Crohn's Disease. The corresponding figures in the adult-onset group were 65.0 percent and 35.0 percent, respectively.

Participants with older-onset IBD were more likely to have comorbidities than those with adult-onset disease (Charlson Comorbidity Index ≥3, 13.3 percent vs 1.6 percent). Within 1 year after the IBD diagnosis, the older-onset vs adult-onset group were treated less often with 5-ASA (41.9 percent vs 54.9 percent), thiopurines (6.8 percent vs 16.6 percent), and biologics (3.6 percent vs 12.6 percent). Medication initiation patterns were consistent at the 5-year follow-up.

Multivariable regression models showed that older-adult IBD was associated with a lower likelihood of initiating thiopurines (adjusted hazard ratios [aHR], 0.44, 95 percent confidence interval [CI], 0.42–0.47), 5-ASA (aHR, 0.77, 95 percent CI, 0.75–0.79), and biologics (aHR, 0.29, 95 percent CI, 0.26–0.31) within 1 year. The results were similar at 5 years.

Moreover, drug persistency for thiopurines, 5-ASA, and biologics within 5 years was comparable between participants in the older-onset and adult-onset groups. The aHR for steroid discontinuation within 1 and 5 years were 0.80 (95 percent CI, 0.76–0.84) and 0.77 (95 percent CI, 0.74–0.80), respectively.

Finally, the risk of surgeries within 5 years was elevated in the older-onset IBD group (ulcerative colitis: aHR, 1.39, 95 percent CI, 1.27–1.52; Crohn's disease: aHR, 1.13, 95 percent CI, 1.04–1.23).

The findings highlight careful consideration among clinicians with regard to suboptimal use of IBD-specific medications in older patients, as well as timely discontinuation of corticosteroids.

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