Elderly-onset (EO) inflammatory bowel disease (IBD) appears to have a similar progression as adult-onset (AO) IBD, according to a recent systematic review and meta-analysis published in Clinical Gastroenterology and Hepatology. Results also showed that patients with EO-IBD were less likely to receive treatment with immunomodulators or biologic agents than were those with AO-IBD.

Rozich and colleagues sought to evaluate progression of EO-IBD in population-based cohort studies in comparison with AO-IBD. Through June 1, 2019, the team identified population-based cohort studies of EO-IBD that reported the cumulative risk of various IBD-related events: hospitalization, surgery, mortality, treatment patterns, and escalation and/or malignancy.

Using a random-effects meta-analysis, the data were assessed as the cumulative risk of each event at 1 year, 5 years, and 10 years for patients with Crohn disease (CD), ulcerative colitis (UC), or both.

In total, 9 studies, including 14,765 patients with EO-IBD (mean/median age range, 68-73), were identified.


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Patients with EO-CD cumulative 1-, 5- and 10-year risk of surgery of 13.0% (95% CI, 10.7-15.7), 22.6% (18.7-27.2) and 27.8% (19.8-37.5), respectively. The cumulative 5-year risk of surgery in patients with EO-CD was similar to the risk in patients with AO-CD (relative risk [RR], 1.04; 95% CI, 0.80-1.34).

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Patients with EO-CD had a 55.4% (95% CI, 53.4%-57.4%) cumulative 5-year risk of exposure to corticosteroids, which again was similar to that of patients with AO-CD (RR, 0.88; 95% CI, 0.78-1.00). However, patients with EO-CD had a significantly lower 5-year risk of exposure to immunomodulators (31.5%; 95% CI, 29.7%-33.4%; RR, 0.62; 95% CI, 0.51-0.77) and to biologic agents (6.5%; 95% CI, 5.6%-7.6%; RR, 0.36; 95% CI, 0.25-0.52) compared with patients with AO-CD.

Patients with EO-UC had a 7.8% (95% CI, 5.0%-12.0%) cumulative 5-year risk of surgery, which was similar to the risk for patients with AO-UC (RR, 1.29; 95% CI, 0.79-2.11).

Patients with EO-UC had a 57.2% (95% CI, 55.6%-58.7%) cumulative 5-year risk of exposure to corticosteroids, which was similar to that of patients with AO-UC (RR, 0.98; 95% CI, 0.91-1.06). Similarly, patients with EO-UC also had significantly lower 5-year risk of exposure to immunomodulators (16.1%; 95% CI, 15.0%-17.2%; RR, 0.58; 95% CI, 0.54-0.62) and to biologic agents (2.0%; 95% CI, 1.6%-2.5%; RR, 0.36; 95% CI, 0.24-0.52) compared with patients with AO-UC.

Though reporting varied across studies, patients with EO-IBD appeared to have increased risk of all-cause mortality compared with the general population; malignancy rates did not appear to be different.

Limitations of the study included variation between studies in criteria for defining and  reporting phenotypes, outcomes, and medication exposures; limited data on rates of comorbidity, frailty, malignancy, mortality, and adverse medication events; and limited data on biologic therapies in general.

“More accurately identifying older patients at higher risks of disease-related vs treatment-related vs non-IBD-related complications will help ascertain risk-benefit trade-offs of immunosuppressive therapy in these patients,” concluded the authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Rozich JJ, Dulai PS, Fumery M, Sandborn WJ, Singh S. Progression of elderly-onset inflammatory bowel diseases: a systematic review and meta-analysis of population-based cohort studies [published online March 3, 2020]. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2020.02.048