P483 Differences in biologic therapy utilisation amongst early and late-onset inflammatory bowel disease
S. Raimundo Fernandes*, C. Baldaia, P. Moura Santos, A. Rita Gonçalves, A. Valente, L. Correia, J. Velosa
Centro Hospitalar Lisboa Norte, Gastrenterology, Lisbon, Portugal
Crohn’s disease (CD) and Ulcerative Colitis (UC) are chronic inflammatory diseases affecting the bowel. CD and UC both present 2 peak ages of incidence. A previous work suggested that late-onset CD requires earlier biologic therapy and may therefore be more aggressive. We sought to validate these findings by assessing the difference in biologic therapy amongst early onset and late-onset disease.
We conducted a single-centre, retrospective study including 291 patients with inflammatory bowel disease under anti-TNF therapy with infliximab or adalimumab from 2000 to 2015. Duration from the time of diagnosis until initiation of biologic treatment was recorded and analysed. Early onset (< 40 years) was compared with late-onset disease (≥ 40 years). We also evaluated potential predictors of requiring anti-TNF in patients with late-onset disease.
Of the 291 patients included in our study, 234 had CD and 57 UC. Further, 27/234 patients with CD (11.5%) and 13/57 patients with UC (28.0%) presented with late-onset disease. Although anti-TNF utilisation was more common in early onset disease (36.3% versus 12.7%, p < 0.001), it was required sooner in patients with late-onset presentation (103 ± 96.7 versus 62.9 ± 62.1 years, p = 0.002). This finding persisted even when adjusted for type of inflammatory bowel disease (p = 0.005 for both CD and UC). In multivariate analysis, predictors of requiring anti-TNF therapy in late-onset CD included younger age (OR 0.927 IC 95% [0.857–1.001], p = 0.05) and immunomodulatory therapy (OR 6.275 IC 95% [1.6232–4.262], p = 0.008), and in UC younger age (OR 0.895 IC 95% [0.815–0.982], p = 0.019) and extensive disease (OR 2.411 IC 95% [1.018–5.709], p = 0.045).
Although less frequent, biologic therapy is initiated sooner in patients with late-onset disease. This suggest that there is a sub-group of patients with late-onset disease who behave more aggressively and require more intensive therapy. Younger age (CD/UC), immunomodulatory therapy (CD) and extensive disease (UC) were identified as potential predictors of a more aggressive course in this group.