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. 2021 Jul 27;27(8):1215-1223.
doi: 10.1093/ibd/izaa308.

Disease- and Treatment-related Complications in Older Patients With Inflammatory Bowel Diseases: Comparison of Adult-onset vs Elderly-onset Disease

Jacob J Rozich  1 , Jiyu Luo  2 , Parambir S Dulai  3 , Angelina E Collins  3 , Lysianne Pham  3 , Brigid S Boland  3 , William J Sandborn  3 , Siddharth Singh  3
Affiliations

Disease- and Treatment-related Complications in Older Patients With Inflammatory Bowel Diseases: Comparison of Adult-onset vs Elderly-onset Disease

Jacob J Rozich et al. Inflamm Bowel Dis. .

Abstract

Background: The incidence and prevalence of inflammatory bowel diseases (IBD) in older adults are rising. There is a limited comparative assessment of risk of disease- and treatment-related complications in older patients (older than 60 years) with adult-onset (age at disease onset, 18-59 years; AO-IBD) vs elderly-onset IBD (age at disease onset, older than 60 years; EO-IBD). We compared clinical outcomes in older patients with IBD with AO-IBD vs EO-IBD.

Methods: We conducted a retrospective cohort study comparing risk of disease-related complications (IBD-related surgery, hospitalization, treatment escalation, clinical flare, or disease complication) and treatment-related complications (serious infection, malignancy, or death) in older patients with AO-IBD vs EO-IBD through Cox proportional hazard analysis, adjusting for age at cohort entry, disease phenotype, disease duration, prior surgery and/or hospitalization, medication use, disease activity at cohort entry, and comorbidities.

Results: We included 356 older patients with IBD (AO-IBD, 191 patients, 67 ± 5 y at cohort entry; EO-IBD, 165 patients, 72 ± 8 y at cohort entry). No significant differences were observed in the risk of disease-related complications in older patients with prevalent vs incident IBD (adjusted hazard ratio [aHR], 0.85; 95% CI, 0.58-1.25), although risk of IBD-related surgery was lower in older patients with prevalent IBD (aHR, 0.47; 95% CI, 0.25-0.89). Older patients with prevalent IBD were significantly less likely to experience treatment-related complications (aHR, 0.58; 95% CI, 0.39-0.87).

Conclusion: Patients with AO-IBD have lower risk of treatment-related complications as they age compared with patients with EO-IBD, without a significant difference in risk of disease-related complications.

Keywords: Crohn’s disease; aging; biologics; colitis; infections.

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Figures

FIGURE 1.
FIGURE 1.
Kaplan-Meier analysis for event-free survival of (A) composite safety, (B) infection, (C) malignancy, and (D) death in adult-onset vs elderly-onset inflammatory bowel diseases. Composite safety is the first of any infection, malignancy, or death.
FIGURE 2.
FIGURE 2.
Kaplan-Meier analysis for event-free survival of (A) composite effectiveness, (B) IBD-related surgery, (C) all-cause hospitalization, (D) treatment escalation, (E) clinical flare, and (F) disease complications. Composite effectiveness is the first of any IBD-related surgery, hospitalization from any cause, treatment escalation, or disease complication. Treatment escalation included any escalation in therapy to immunomodulating, biologic, combination thereof, or other immunosuppressing medications.
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