Patients with elderly onset inflammatory bowel disease have a decreased chance of initiation of all types of medications and increased risk of surgeries—A nationwide cohort study

Abstract

Summary Objective In patients with elderly (≥60 years) onset inflammatory bowel disease (IBD), we studied initiation of medications, drug persistency and surgeries. Design A nationwide cohort study based on Danish registries, comprising incident IBD patients ≥18 years from 1995 to 2020 (N = 69,039). Patients were divided into elderly (N = 19,187) and adult onset (N = 49,852). Outcomes were initiation of thiopurines, 5‐ASA, biologics and corticosteroids within 1 and 5 years after diagnosis, and for those who initiated medications, we estimated drug persistency. Surgeries were examined within 1 and 5 years. We used regression models controlling for covariates. Results In elderly patients, the adjusted hazard ratios (aHR) for initiating thiopurines, 5‐ASA and biologics within 1 year were 0.44 (95% CI 0.42–0.47), 0.77 (95% CI 0.75–0.79) and 0.29 (95% CI 0.26–0.31) respectively. The results were similar within 5 years. In elderly patients, drug persistency for thiopurines, 5‐ASA and biologics was not impaired within 5 years. The aHR of stopping steroids within 1 and 5 years were 0.80 (95% CI 0.76–0.84) and 0.77 (95% CI 0.74–0.80) respectively. The risk of surgeries was increased in the elderly patients (in ulcerative colitis, within 5 years, aHR 1.39 [95% CI 1.27–1.52], and in Crohn's disease 1.13 [95% CI 1.04–1.23]). Conclusion We found significantly low chance of initiation of IBD medications in elderly patients, the reason may not be due to mild disease course. In elderly patients, drug persistency was comparable to adults. Clinicians should carefully consider whether they underuse IBD‐specific medications in elderly patients, and special attention should be applied to timely discontinuation of corticosteroids.

Older Adult-Onset of Inflammatory Bowel Diseases Is Associated With Higher Utilization of Analgesics: A Nationwide Cohort Study

“…Our study also differentiates strong from weak opioids such as tramadol and codeine because stronger opioids may be associated with more complications, particularly among older adults (10). Furthermore, our attention to individuals with older adult-onset IBD helps to fill important knowledge gaps regarding a poorly studied demographic in clinical and epidemiologic research (7,26,27,39,40).…”

“…Recent data suggest that older adults with IBD may be treated differently compared with other age demographics (27). In a study using Danish nationwide registries between 1995 and 2020, Nørg ard et al (27) determined that older adults diagnosed with IBD were significantly less likely to initiate biologics, thiopurines, and 5-aminosalicylic acid treatments within 1 and 5 years after IBD diagnosis but were more likely to undergo IBD surgeries compared with younger adults. We redemonstrated in this study that older adults less commonly initiated biologic therapies within 1 year after IBD diagnosis compared with all other age groups.…”

“…The exposure was age at IBD onset, which was used to stratify the population into 3 groups: young adult-onset IBD (18-39 years of age), adult-onset IBD (40-59 years of age), and older adult-onset IBD (60 years or older) (26,27).…”

“…Other variables collected included sex, year of IBD diagnosis, IBD type (CD or UC), IBD surgery within 1 year after IBD diagnosis, and initiation of biologic therapies available in Denmark (infliximab, adalimumab, golimumab, ustekinumab, and vedolizumab; small molecule agents are not routinely available) within 1 year after IBD diagnosis (27).…”

Editorial: elderly onset inflammatory bowel disease ‐ clues from the largest population‐based cohort study

“…Nørgård et al 5 analysed almost 70,000 patients diagnosed with IBD over a 25‐year period; one‐third were diagnosed at 60 years or older. The likelihood of starting specific therapy was significantly lower in elderly onset patients, for biologics (~70%) and thiopurines (~55%), but also for 5‐ASA (~25%) despite its well‐known safety profile.…”