J Clin Gastroenterol. 2022 Jul 1;56(6):529-535.doi: 10.1097/MCG.0000000000001557. Epub 2021 Jun 11.

Edward L Barnes ¹, John S Hanson ², Miguel D Regueiro ³, Sumona Saha ⁴, Bruce E Sands ⁵, David T Rubin ⁶, Marla C Dubinsky ⁷, Corey A Siegel ⁸, Derek R Gazis ⁹, Julie M Crawford ⁹, Millie D Long ¹

Author information

¹Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill.

²Atrium Health Gastroenterology and Hepatology, Charlotte.

³Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH.

⁴Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI.

⁵Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai.

⁶IBD Center, The University of Chicago Medicine, Chicago, IL.

⁷Division of Pediatric Gastroenterology, The Susan & Leonard Feinstein IBD Clinical Center at Icahn School of Medicine at Mount Sinai, New York, NY.

⁸Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

⁹Target RWE, Health Evidence Solutions, Durham, NC.

Abstract

Goal: The goal of this study was to describe medication utilization patterns in older inflammatory bowel disease (IBD) patients.

Background: Despite a growing population of older patients with Crohn's disease (CD) and ulcerative colitis (UC), questions remain regarding medication utilization patterns in comparison to younger populations.

Materials and methods: We collected data from the 34 sites in TARGET-IBD, a multicenter, observational cohort. The primary outcome in this study was the IBD-specific therapy utilized among older patients with IBD compared with younger age groups. Therapy use was analyzed using pairwise comparisons and then the odds of IBD-specific therapy use among patients older than age 65 were evaluated using multivariable logistic regression models.

Results: We identified 2980 patients with IBD (61% CD). In multivariable analysis, younger patients with UC were significantly less likely to utilize aminosalicylate monotherapy when compared with patients above 65 years [age 18 to 29: adjusted odds ratio (aOR)=0.51, 95% confidence interval (CI): 0.33-0.78]. In patients with CD, younger patients were significantly less likely to use aminosalicylate monotherapy when compared with patients above 65 (greatest difference age 18 to 29: aOR=0.31, 95% CI: 0.18-0.52). Younger patients with CD and UC were significantly more likely to use anti-tumor necrosis factor monotherapy than patients above 65 years (age 18 to 29: aOR=3.87, 95% CI: 2.47-6.06 and aOR=2.68, 95% CI: 1.29-5.58, respectively).

Conclusions: Older patients with IBD demonstrate significant differences in medication utilization, including more aminosalicylate monotherapy and less anti-tumor necrosis factor monotherapy compared with younger age groups. Given the aging population in the United States, these utilization patterns may have long-term implications for disease control.