Elderly patients with inflammatory bowel disease: Updated review of the therapeutic landscape

Abstract

High-quality data remains scarce in terms of optimal management strategies in the elderly inflammatory bowel disease (IBD) population. Indeed, available trials have been mostly retrospective, of small sample size, likely owing to under-representation of such a population in the major randomized controlled trials. However, in the last five years, there has been a steady increase in the number of published trials, helping clarify the estimated benefits and toxicity of the existing IBD armamentarium. In the Everhov trial, prescription strategies were recorded over an average follow-up of 4.2 years. A minority of elderly IBD patients (1%-3%) were treated with biologics within the five years following diagnosis, whilst almost a quarter of these patients were receiving corticosteroid therapy at year five of follow-up, despite its multiple toxicities. The low use of biologic agents in real-life settings likely stems from limited data suggesting lower efficacy and higher toxicity. This minireview will aim to highlight current outcome measurements as it portends the elderly IBD patient, as well as summarize the available therapeutic strategies in view of a growing body of evidence.

Ciclosporin or Infliximab as Rescue Therapy in Acute Glucorticosteroid-Refractory Ulcerative Colitis: Systematic Review and Network Meta-Analysis

“…35 However, infliximab is also associated with potentially severe adverse events including an increased risk of opportunistic infection and infusion reactions, 36 and there are concerns about its use in elderly patients. 37 Both the aforementioned meta-analyses found that there were no significant differences between infliximab and ciclosporin in terms of drug-related adverse events, serious adverse events, or mortality. 14,33 Our results also demonstrated no significant differences between the two drugs in terms of serious adverse events.…”

Serum triiodothyronine‐to‐thyroxine (T3/T4) ratio predicts therapeutic outcome to biological therapies in elderly IBD patients

“…33 Unfortunately, however, faecal calprotectin is not validated in the elderly population, mostly because FC levels can increase also in the setting of other diseases, as well as under treatment with certain drugs, such as proton pump inhibitors and non-steroidal anti-inflammatory drugs, which are commonly used in the elderly TA B L E 1 Characteristics of patients who achieved (responders) or did not achieve (non-responders) mucosal healing population. 34,35 Thus, faecal calprotectin specificity might be low in the elderly population. 35 The T3/T4 ratio has been described as an independent marker of frailty in elderly patients.…”

“…34,35 Thus, faecal calprotectin specificity might be low in the elderly population. 35 The T3/T4 ratio has been described as an independent marker of frailty in elderly patients. 20 Despite no previous studies had evaluated this biomarker in IBD patients, a recent review showed that frail elderly patients are more susceptible to the complications of IBD and display lower healing capacity.…”

“…Conversely, faecal calprotectin is the most important biomarker in the setting of IBD, and we have recently shown that its assessment after the induction of biological therapy could predict mucosal healing, regardless of the type of drug 33 . Unfortunately, however, faecal calprotectin is not validated in the elderly population, mostly because FC levels can increase also in the setting of other diseases, as well as under treatment with certain drugs, such as proton pump inhibitors and non‐steroidal anti‐inflammatory drugs, which are commonly used in the elderly population 34,35 . Thus, faecal calprotectin specificity might be low in the elderly population 35 …”

“…Unfortunately, however, faecal calprotectin is not validated in the elderly population, mostly because FC levels can increase also in the setting of other diseases, as well as under treatment with certain drugs, such as proton pump inhibitors and non‐steroidal anti‐inflammatory drugs, which are commonly used in the elderly population 34,35 . Thus, faecal calprotectin specificity might be low in the elderly population 35 …”