P606. Phenotypic characteristics and use of therapeutic resources in elderly-onset inflammatory bowel disease: A multicentre, case–control study
It has been reported that IBD onset occurs at old age in up to 10% of cases. Elderly patients have more comorbidities and, therefore, a potential increased risk of drug adverse effects, increased likelihood of hospital admissions and postoperative complications.
Aims: To evaluate the phenotypic characteristics and use of therapeutic resources in patients with elderly-onset IBD.
Retrospective, case–control, multicentre study. All those patients diagnosed with IBD over the age of 60 years (cases) since 2000 and with a follow-up >12 months were identified from the IBD databases of each centre. Cases were compared with controls, who were diagnosed with IBD between 18 and 40 years of age, and matched by year of diagnosis, gender, and type of IBD.
A total of 1,374 cases and 1,374 matched controls were included, of whom 43% women, 62% ulcerative colitis (UC), 36% Crohn's disease (CD) and 2% unclassified IBD. The mean age at diagnosis was 68 years (range, 60–87) within cases and 28 years (range, 18–45) within controls. 59% of the cases (but only 3% of controls) had at least one cardiovascular risk factor (arterial hypertension, dyslipidemia or diabetes). The proportion of active smokers at the time of IBD diagnosis was 25% among controls and 13% among cases. Phenotypically, elderly-onset patients had a lower proportion of extensive UC (p < 0.0001), and a higher proportion of stenosing and a lower proportion of penetrating pattern (p < 0.0001) and exclusive colonic location (p < 0.0001). Elderly-onset patients had a lower rate of IBD-related complications (p = 0.009) but a higher prevalence of thrombotic events (p < 0.0001). Regarding the use of therapeutic resources, there was a significantly lower use of corticosteroids (p < 0.0001), immunomodulators (p < 0.0001) and biological agents (p < 0.0001) in elderly-onset patients as compared to controls, but a similar rate of surgeries. Finally, elderly-onset patients had a higher rate of hospitalizations (p < 0.0001), neoplasms (p < 0.0001) and deaths (p < 0.0001). In the multivariate analysis, elderly-onset of IBD was independently associated to a decreased need of immunomodulators and biological agents, and an increased need of hospital admissions.
Elderly-onset IBD is associated to a less severe/complicated phenotype and the lesser use of immunosuppressive therapies, which probably accounts for a non-increased IBD-related morbidity. Age at diagnosis might explain the increase in the rate of hospitalizations among elderly patients.