Very late-onset IBD

November 19, 2024

Issue 22

Clinical Question

How do care patterns and outcomes differ for IBD patients diagnosed very late in life?

Editor’s Bottom Line

Patients newly diagnosed with IBD after age 80 are just as likely to require steroids but less likely than their counterparts diagnosed in their 60s and 70s to undergo surgery and/or receive steroid-sparing therapies such as biologics.

Reference

Singh S, Poulsen GJ, Bisgaard TH, et al. Epidemiology of Elderly Onset IBD: A Nationwide Population-Based Cohort Study. Clin Gastroenterol Hepatol. Epub ahead of print August 30, 2024. https://www.cghjournal.org/abstract

Synopsis

To describe the incidence and natural history of patients diagnosed with IBD at a late age, Danish and American researchers turned to data from the Danish National Patient Register between 1980 and 2018 and identified 3,459 patients with onset of Crohn’s disease (CD) at ≥60 years of age, 47% of whom were diagnosed between 70–79 years of age and 12.9% who were diagnosed ≥80 years of age. They also found 10,774 patients diagnosed with ulcerative colitis (UC) at 60 years of age or later, 49.1% of whom were diagnosed between 60–69, 37.2% who were diagnosed between 70–79 and 13.7% who were diagnosed ≥80 years of age.

For the CD group, the five-year cumulative incidence of CD-related hospitalization was comparable for those diagnosed in their 70s and those diagnosed in their 80s. The likelihood of major abdominal surgery for CD decreased with age (29% for 60–69 vs. 15% for ≥80; p<0.01), as did the risk of minor abdominal and perianal surgery (p<0.01).

Hospitalization and surgery rates changed over the periods studied, with the risk of CD-related hospitalizations and surgeries two-to-three-fold lower in 2010–2018 than in 1980–1989 (p<0.01 for both).

Use of corticosteroids for CD was similar among the age groups and over the course of the study period, while cumulative use of immunomodulators (33% for 60–69 vs. 24% for 70–79 and 10% for ≥80) and anti-tumor necrosis factor (TNF) drugs (13% vs. 7% and 2%, respectively) was significantly lower with older age (p<0.01 for both).

Older CD patients had a higher risk of serious infection (5-year cumulative incidence: 20% for 60–69 years of age; 28% for 70–79; 32% for ≥80 years of age; p<0.01), but there were no significant differences in the risk of major adverse cardiovascular events, venous thromboembolism or cancer. Over the course of the study period, the risk of serious infections increased across all age groups.

In the UC group, the five-year cumulative incidence of UC-related hospitalizations was higher in older patients (36% for both 70–79 and ≥80 years vs. 32% for 60–69; p<0.01). The five-year cumulative incidence of colectomy was significantly lower in patients diagnosed with UC in their 80s (10%, 12% and 6% for 60–69, 70–79 and ≥80, respectively; p<0.01). The risk of colectomy decreased in the most recent decade of the study period, compared to the first decade, as did the risk of UC-related hospitalization (p<0.01 for both).

As with CD patients, patients of increasing age were less likely to receive immunosuppressants (five-year cumulative use: 15%, 13% and 6% for 60–69, 70–79 and ≥80 years, respectively; p<0.01) and anti-TNF medications (five-year cumulative use: 5%, 3% and 1%, respectively; p<0.01).

UC patients diagnosed in their 80s had a higher risk of serious infections, major adverse cardiovascular events, venous thromboembolism and cancer, compared to those diagnosed between 60–69 years of age (p<0.01 for all). The risk of all these complications was significantly higher between 2010 and 2018, compared to 1980 and 1989, for those diagnosed in their eighth and ninth decades (p<0.01).

 

Details

Study Design: Nationwide, register-based cohort study
Funding: The National Institute of Diabetes and Kidney Diseases and the Danish National Research Foundation.
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b