Epidemiology and Natural History of Elderly-onset Inflammatory Bowel Disease: Results From a Territory-wide Hong Kong IBD Registry

Abstract

Background Elderly-onset inflammatory bowel disease (IBD), defined as age ≥60 at diagnosis, is increasing worldwide. We aimed to compare clinical characteristics and natural history of elderly-onset IBD patients to adult-onset IBD patients. Methods Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features and outcomes of elderly-onset IBD patients were compared to adult-onset IBD patients. Results A total of 2413 patients were identified, of whom 270 (11.2%) had elderly-onset IBD. Median follow-up duration was 111 months (Interquartile range [IQR]: 68-165 months). Ratio of ulcerative colitis (UC): Crohn’s disease (CD) was higher in elderly-onset IBD than adult-onset IBD patients (3.82:1 vs. 1.39:1; p&0.001). Elderly-onset CD had less perianal involvement (5.4% vs. 25.4%; p&.001) than adult-onset. Elderly-onset IBD patients had significantly lower cumulative use of immunomodulators (p=0.001) and biologics (p=0.04). Elderly-onset IBD was associated with higher risks of cytomegalovirus colitis (Odds ratio [OR]: 3.07; 95% Confidence Interval (CI) 1.92-4.89; p&0.001); herpes zoster (OR: 2.42; 95% CI: 1.22-4.80; p=0.12) and all cancer development (Hazard ratio: 2.97; 95% CI: 1.84-4.79; p&0.001). They also had increased number of overall hospitalization (OR: 1.14; 95% CI 1.09-1.20; p&0.001), infections-related hospitalization (OR: 1.87; 95% CI 1.47-2.38; p&0.001) and IBD-related hospitalization (OR: 1.09; 95% CI: 1.04- 1.15; p=0.001) compared to adult-onset IBD. Conclusion Elderly-onset IBD patients were associated with increased risk of infections, cancer development and increased infections- and IBD-related hospitalizations. Specific therapeutic strategies to target this special population is needed.

Clinical characteristics of ulcerative colitis in elderly patients

“…At present, the data of efficacy of anti‐TNF agents are inconsistent in the treatment of elderly UC patient. In a multicenter study from Italy, the clinical remission rate of elderly UC patients treated with anti‐TNF agents (infliximab or adalimumab) was similar to that of younger patients (59% vs 57%, respectively) 5 . However, another study observed lower rate of response to anti‐TNF therapy at 6 months in older IBD patients 48 .…”

“…In a multicenter study from Italy, the clinical remission rate of elderly UC patients treated with anti‐TNF agents (infliximab or adalimumab) was similar to that of younger patients (59% vs 57%, respectively). 5 However, another study observed lower rate of response to anti‐TNF therapy at 6 months in older IBD patients. 48 The poor clinical response of elderly patients initiating anti‐TNF treatment is only in the short‐term at 10 weeks, whereas there was no significant difference in the long‐term clinical response at ≥6 months between elderly patients and non‐elderly patients.…”

“…However, compared with younger UC patients treated with anti‐TNF agents, elderly patients present higher discontinuation rate of anti‐TNF agents, due to significantly increased risk of infections, malignancy, and possible death. 5 , 50 Hence, anti‐TNF agents should be administered to elderly patients with caution.…”

“…Compared with the younger population, the health status of the elderly patients is more heterogeneous, which makes the clinicians should assess an individual's frailty, rather than only considering an individual's chronological/biological age when making management decisions in the elderly. Suboptimal treatment considering the increased risk of infections and cancer development associated with the immunomodulators and biologics leads to poor clinical outcome in elderly UC patients 5 …”

“…Suboptimal treatment considering the increased risk of infections and cancer development associated with the immunomodulators and biologics leads to poor clinical outcome in elderly UC patients. 5 …”