Elderly-Onset Inflammatory Bowel Disease Has Distinct Disease Characteristics and Treatment Patterns

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Epidemiology

Background:

• Elderly-onset inflammatory bowel disease (IBD), diagnosed at age 60 or older, has distinct clinical characteristics.
• Understanding these differences is crucial for optimizing patient care and treatment strategies.

Purpose of the Study:

• To compare disease phenotypes and treatment exposures between adult-onset (18-59 years) and elderly-onset (≥60 years) IBD patients.
• To identify unique features of IBD in the elderly population.

Main Methods:

• A real-life registry-based cohort study comparing adult- and elderly-onset IBD patients diagnosed between 2000-2022.
• Analysis included demographics, disease characteristics (involvement, phenotype, complications), and treatment exposures (medications, surgery).
• Follow-up duration was at least 12 months.

Main Results:

• Elderly-onset IBD (9% of cohort) showed a higher prevalence of colon-only involvement, including ulcerative colitis (UC) and colonic L2 Crohn's disease (CD).
• Elderly-onset CD exhibited less ileocolonic L3 disease, less penetrating B3 phenotype, and less perianal involvement compared to adult-onset CD.
• Elderly-onset patients received more 5-ASA, but significantly less biologics/JAK inhibitors, demonstrating higher 15-year biologic-free survival. Vedolizumab was preferred over anti-TNFs as a first-line biologic.
• No significant differences in IBD-related surgeries or steroid use were observed between the groups.

Conclusions:

• Elderly-onset IBD is characterized by a higher prevalence of colon-only disease (UC and L2 CD).
• Treatment approaches for elderly-onset IBD prioritize 5-ASA and involve reduced use of biologics.
• Vedolizumab appears to be a preferred biologic agent over anti-TNFs in elderly IBD patients.