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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

Background

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.

Methods

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.

Results

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.

 

Conclusion

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.