Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

Abstract

Background As the American population is aging, the number of older people with IBD is increasing. We used clinical data from the Sinai-Helmsley Alliance for Research Excellence (SHARE), a prospective cohort, to examine disease and treatment differences in older adults. Methods We performed a cross-sectional study assessing demographics and disease behavior by age at diagnosis with univariate, bivariate and multivariate analyses. “Older-onset” patients were diagnosed after age 60, “younger-onset” patients were diagnosed before age 60, but are older than 60 years and the remainder were “young”. Results There were 91 older-onset, 389 younger-onset and 3431 young Crohn's disease (CD) patients. Older-onset patients had more ileal (37%) and colonic (27%) disease compared to younger-onset and young patients. There were no differences in disease behavior, location or surgeries between older-onset and young CD patients within 5 years of diagnosis. Older-onset patients with inflammatory disease had a higher odds of being in remission. Young patients reported more anti-TNF and thiopurine use compared to younger-onset and older-onset patients (p <0.01). There were 98 older-onset, 218 younger-onset and 1702 young ulcerative colitis (UC) patients. There were no differences in disease extent, activity index or surgeries. Young UC patients reported more anti-TNF use (26%) compared to younger-onset patients (17%, p <0.01). Conclusions Disease behavior or location were not different between younger and older adults with IBD. Older patients were less likely to be treated with immunosuppression. If older patients have similar disease behavior, less frequent treatment with immunosuppressives may risk sub-optimally controlled disease.

Iranian Registry of Crohn’s and Colitis: study profile of first nation-wide inflammatory bowel disease registry in Middle East

“…Similar to IRCC, multicenter registries are held in other part of the world. For example, SHARE registry in the United States is cooperation of 7 referral IBD centers focused mostly on biomedical researches and treatment of IBD [22]. There are also multicenter IBD registries in Europe such as Austrian IBD center cohort which is comprised of 14 tertiary centers and aimed to study on disease phenotype and activity and treatment of IBD [23].…”

Older Adult Patients Use More Aminosalicylate Monotherapy Compared With Younger Patients With Inflammatory Bowel Disease

“…In an evaluation from the Sinai-Helmsley Alliance for Research Excellence (SHARE) cohort, older patients were less likely to utilize anti-TNF and thiopurine therapies, although no differences were noted in disease extent, activity, or in IBD-related surgery. 29 In our analyses, the highest use of combination therapy with an anti-TNF and an immunomodulator was noted in the 30-to 49-year age group, which may also indicate a concern regarding the malignancy risk of these therapies in both the youngest and oldest age ranges in our study population.…”

“…Although this could potentially be a marker of a less severe disease course among patients with older-onset IBD, in the same meta-analysis, patients with older-onset UC were significantly more likely to undergo surgery when compared with younger-onset patients with UC. In an evaluation from the Sinai-Helmsley Alliance for Research Excellence (SHARE) cohort, older patients were less likely to utilize anti-TNF and thiopurine therapies, although no differences were noted in disease extent, activity, or in IBD-related surgery 29. In our analyses, the highest use of combination therapy with an anti-TNF and an immunomodulator was noted in the 30- to 49-year age group, which may also indicate a concern regarding the malignancy risk of these therapies in both the youngest and oldest age ranges in our study population.…”

Challenges in the Management of Inflammatory Bowel Disease

“…Youngeronset, i.e., diagnosed before age 60 but not in childhood or adolescence, UC patients had more gastrointestinal surgery (25%) compared to young patients (16%) and those with older onset (5%) but had no difference in remission rates. Youngeronset UC and CD patients consistently had greater exposure to biologic therapy and IMD than those with older onset (Kochar et al 2017).…”