Outcomes with elderly-onset IBD

November 18, 2020

Clinical Question

Do outcomes and treatment patterns differ for elderly-onset IBD?

Editor’s Bottom Line

Patients with elderly-onset IBD face risks of hospitalization and/or surgery similar to younger patients, but are less likely to receive advance therapies. Treatments algorithms for this growing group of patients should be reassessed.

Reference

Rozich, JJ, Dulai PS, Fumery M, et al. Progression of Elderly Onset Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis of Population-Based Cohort Studies. Clin Gastroenterol Hepatol.2020;18(11):2437–47.e6; https://doi.org/10.1016/j.cgh.2020.02.048

Synopsis

This systematic review examined treatment patterns and outcomes of 14,765 patients with elderly-onset IBD who were included in nine studies of seven population-based cohorts. Six of the cohorts were based in Europe and one was based in Canada, and most studies were conducted in the 1990s and 2000s. Each included a comparison cohort of age-matched individuals without IBD, or of individuals with non-elderly adult-onset IBD. Elderly-onset IBD patients were a mean 68 years of age at the time of study enrolment and the mean follow-up was 4.2 years.

Results showed that for those with Crohn’s disease (CD), risk of surgery was similar for those with elderly-onset CD or adult-onset CD. Corticosteroid use rates were also similar between the two groups but those with elderly-onset CD were significantly less likely to receive immunomodulating agents (RR: 0.62; 95% CI, 0.51–0.77; p<0.05) or biologic drugs (RR: 0.36; 95% CI, 0.25–0.52; p<0.05). Among those with elderly-onset ulcerative colitis (UC), risk of surgery and corticosteroid use was statistically similar to those with adult-onset UC. However, rates of immunomodulator use (RR: 0.58; 95% CI, 0.54–0.62; p<0.05) and biologic drug use (RR: 0.36; 95% CI, 0.24–0.52; p<0.05) were both significantly lower.

Analyses found similar risk for hospitalization for elderly-onset and adult-onset IBD patients. One study compared mortality rates for elderly-onset IBD patients and a general age-matched population and found a 1.5-fold increased risk of death among those with IBD. Another study examined cancer rates and reported a similar risk for malignancies among elderly-onset IBD patients and age-matched population controls.

Details

Study Design: Systematic review

Funding: National Institute of Diabetes and Kidney Diseases, the American Gastroenterological Association, American College of Gastroenterology and the Crohn’s and Colitis Foundation

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 2a