The Efficacy and Safety of Thiopurines Do Not Differ Between Geriatric and Non-Geriatric Patients with Inflammatory...

Background and Aim: The patterns of medication use among elderly patients with inflammatory bowel disease vary owing to several factors. This study aimed to present the outcomes of immunomodulator therapy in both geriatric and non-geriatric patient groups, highlighting the differences in treatment effectiveness, reasons for discontinuation, and incidence of side effects between the two groups. Materials and Methods: A retrospective database was established by reviewing the records of patients with inflammatory bowel disease aged 18 years and older who received immunomodulatory therapy at our clinic over a seven-year period. Patients aged 65 years or older were included in the geriatric cohort. In addition to demographic and clinical variables, disease activity in ulcerative colitis patients was assessed using the Mayo Disease Activity Index and the Rachmilewitz Endoscopic Activity Index, whereas the Harvey-Bradshaw Index was used for Crohn's disease patients. Results: This study included 120 patients, comprising 52 with ulcerative colitis and 68 with Crohn's disease. The median age was 66.5 years (range: 23-87), with 64 patients (53.3%) classified as geriatric (≥65 years). Immunomodulator therapy was discontinued owing to side effects in 37 patients (30.8%) and remission in 13 patients (10.8%). In addition, 29 patients (24.2%) did not respond to the treatment. During follow-up, 3 patients (2.5%) developed malignancy and 1 patient (0.8%) died. No significant differences were observed between the geriatric and non-geriatric groups regarding the type of inflammatory bowel disease, duration of therapy, concomitant treatments, reasons for discontinuation, side effects, occurrence of malignancy, malignancy type, or mortality. Conclusion: With careful patient selection and close monitoring, immunomodulator therapy in elderly patients with inflammatory bowel disease can achieve similar effectiveness and risk of side effects as those observed in younger patient groups.