Comorbidities Rather Than Age Are Associated With the Use of Immunomodulators in Elderly-onset Inflammatory Bowel Disease

Kariyawasam VC1,2, Kim S1,3, Mourad FH1, Selinger CP1,4, Katelaris PH1,2, Brian Jones D1,2, McDonald C1, Barr G1, Chapman G1, Colliwshaw J1, Lunney PC1,2, Middleton K1,2, Wang RR1, Huang T1,2, Andrews J5, Pathirana PW1,3, Leong RW1,3. Inflamm Bowel Dis. 2018 Dec 29. doi: 10.1093/ibd/izy389. [Epub ahead of print]

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1 Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.

2 Faculty of Medicine, University of Sydney, Sydney, Australia.

3 Faculty of Medicine, The University of New South Wales, Sydney, Australia.

4 Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.

5 IBD Services, Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia.


BACKGROUND AND AIM: The use of immunomodulators (IMs) is often avoided in elderly patients with inflammatory boweldisease (IBD) due to concerns about complications. Our aim is to compare the use of IMs in elderly and younger patients with Crohn's disease (CD) or ulcerative colitis (UC) and identify markers that predict their use.

METHODS: In this retrospective cohort study, patients diagnosed with IBD from 1970 to 2009 were recruited from the "Sydney IBD Cohort." Patients diagnosed at age 60 years old or older and between 16 and old 40 years were classified as "elderly-onset" and "young-onset" respectively.

RESULTS: A total of 255 elderly-onset patients (115 CD, 140 UC) and 1244 young-onset patients (657 CD, 587 UC) were recruited. Most elderly-onset patients had colonic CD (61.4%), whereas young-onset patients had predominantly ileocolonic CD (42.8%, P < 0.0001). Left-sided UC was the most common disease localization for both elderly-onset (52.1%) and young-onset patients (42.2%, P = 0.013). The cumulative probability of IM exposure at 5 years post-diagnosis was significantly less in elderly-onset patients compared with young-onset patients for CD (20.0% vs 33.4%, P = 0.0002) and UC (7.8% vs 13.4%, P = 0.0007). Age at diagnosis was not associated with the time to IMs introduction. Charlson Comorbidity Index was shown to delay IM introduction in CD (hazard ratio [HR] 0.863; 95% CI, 0.787-0.946; P = 0.002) and UC (HR 0.807; 95% CI, 0.711-0.917; P = 0.001). Early IM use was associated with reduced need for abdominal and perianal surgery in CD (HR 0.177; 95% CI, 0.089-0.351; P < 0.0001).

CONCLUSIONS: Comorbidity and not age at diagnosis is associated with IM introduction. Early IM is associated with reduced surgery in both young- and elderly-onset CD but not UC.

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