OP005. Is elderly-onset ulcerative colitis a different entity? - Natural disease course and treatment response compared to adult-onset disease in the population-based IBD-SL cohort
S. Jeuring1,2, T. Van den Heuvel1,2, M. Zeegers3,4, W. Hameeteman1, M. Romberg-Camps5, L. Oostenbrug6, A. Masclee1,2, D. Jonkers1,2, M. Pierik1,2, 1Maastricht University Medical Center+, Internal Medicine - Division Gastroenterology-Hepatology, Maastricht, Netherlands, 2Maastricht University Medical Center+, NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht, Netherlands, 3University of Birmingham, Epidemiology and Public Health, Birmingham, United Kingdom, 4Maastricht University Medical Center+, Complex Genetics, Cluster of Genetics and Cell Biology, Maastricht, Netherlands, 5ORBIS Medical Centre, Gastroenterology and Hepatology, Sittard, Netherlands, 6Atrium Medical Center, Internal Medicine and Gastroenterology, Heerlen, Netherlands
Population ageing is a worldwide demographic phenomenon. Since the incidence of ulcerative colitis (UC) is increasing, elderly-onset UC will become more prevalent in the near future. It is unclear whether elderly-onset UC is a different phenotypic subgroup, requiring different treatment strategies. Information on disease course and treatment response of elderly-onset UC patients is scarce and conflicting, and often derived from small, selected UC populations. Therefore, we aimed to compare disease course and treatment response between adult- and elderly-onset UC in our population-based IBD-SL cohort.
Since 1991, incident IBD cases in the South-Limburg (SL) area, The Netherlands, are included in our population-based IBD-SL cohort. The natural disease course was compared between adult-onset UC (i.e. <60 years of age at diagnosis) and elderly-onset UC (i.e. ≥60 years of age at diagnosis) in terms of progression of disease extent, use of immunosuppressive or anti-TNFα agents, hospitalisation and colectomy. Also long-term response to immunosuppressive and anti-TNFα treatment was assessed. Data were analysed with a Kaplan–Meier survival curve, and hazard ratios (HR) of age at diagnosis were calculated using a Cox regression model, while correcting for confounders.
In total, 373 UC patients with elderly-onset (EO) and 1288 with adult-onset (AO) were included. Median follow-up was 7.1 years (IQR 3.7–13.5) and 9.0 years (IQR 4.6–15.2), respectively. The proportion of elderly in newly-diagnosed UC patients increased over time (9.2% to 17.4%, r2 = 0.51, p < 0.01). In elderly, more left-sided disease (56.7% vs. 45.3%, p < 0.01) and less rectal disease (26.3% vs. 36.4%, p < 0.01) were observed at diagnosis. The risk of hospitalisation was higher in EO patients (HR 1.38; 95% CI 1.10–1.73), while the risk of more hospitalisations (HR 1.10; 95% CI 0.75–1.60), the risk of colectomy (HR 0.96; 95% CI 0.61–1.51), and the risk of progression of disease extent (HR 1.00; 95% CI 0.74–1.35) did not differ between groups. EO patients were less likely to receive immunosuppressive (HR 0.66; 95% CI 0.50–0.87) or anti-TNFα treatment (HR 0.42; 95% CI 0.25–0.72) (Figure).
Risk of treatment failure was comparable (HR 1.10; 95% CI 0.69–1.74 and HR 1.38; 95% CI 0.58–3.24, respectively) between groups.
In this population-based UC cohort, elderly-onset UC behaved differently compared to adult-onset UC, reflected by a reduced use of immunosuppressive and anti-TNFα treatment, without consequent increased need for multiple hospitalisations or colectomy.