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.