P111 Differences in therapies and intestinal resection rates between adult and elderly onset Crohn’s disease
C. Alexakis*1, S. Saxena2, V. Chhaya1, E. Cecil2, R. Pollok1
1St George’s Hospital, Gastroenterology, London, United Kingdom, 2Department of Primary Care and Public Health, Imperial College, London, United Kingdom
Inflammatory bowel disease, including Crohn’’s disease (CD), is increasing across all age groups. However, very little is known about the disease processes and outcomes in patients who develop CD at older ages. We aimed to compare differences in prescribing and surgery between elderly onset CD, and adult-onset disease, using a nationally representative primary health care dataset.
Data were extracted from the Clinical Practice Research Datalink (CPRD). This is a large national research database that represents 8% of the British population. Incident cases of elderly and adult-onset CD were extracted for the period 1990–2010, based on the validated Read code lists for the condition. For each patient, detailed information on demographics, prescription records, and surgical procedures were recorded. Our main outcome was the risk of first intestinal resection. We compared outcomes in patients with adult-onset CD (ages 17–59 years) versus elderly onset CD (diagnosis aged 60 years or more). Risk of first intestinal resection was analysed using Kaplan–Meier survival curves, and Cox proportional hazard modelling. We also compared socio-demographic characteristics and prescribing of treatments between age groups using X2 and T-tests.
We identified 1 349 cases of elderly onset CD and 5 141 cases of adult-onset CD with a mean follow-up of 4.7 and 5.4 years, respectively. Mean age at diagnosis was 71.8 and 35.6 years in each group. Male sex proportion was lower in the elderly onset group (40.1% vs 43.4%, p = 0.03). The proportion of smokers was also lower in the elderly onset group (22.4% vs 35.6%, p < 0.0001). The elderly onset group were prescribed fewer IBD medications including corticosteroids (52.5% vs 57.0%, p = 0.003), 5-ASA medications (63.7% vs 70.2%, p < 0.0001), and thiopurines (16.4% vs 33.8%, p < 0.0001). The 1-, 5-, and 10-year risk of first intestinal resection was 9.5%, 14.6%, and 17.9% in the elderly group and 12.2%, 19.0%, and 24.4% in the adult-onset group (log rank test for trend, p = 0.0002), respectively. In all group multivariate analysis, having elderly onset disease was associated with a reduced risk of first intestinal resection (HR 0.79, p = 0.003). In subgroup analysis, smoking was predictive for the need for intestinal resection in the elderly onset group (HR 1.2, p = 0.007).
Elderly onset CD follows a less aggressive course with a reduced requirement for corticosteroids, thiopurines, and intestinal resection. This should be considered when managing such patients, given the associated risk of side effects and complications of IBD medications and surgery within this age category.