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Rusher A, Araka E, Ananthakrishnan AN, Ritchie C, Kochar B. IBD Is Like a Tree: Reflections From Older Adults With Inflammatory Bowel Disease. Inflamm Bowel Dis 2024:izae139. [PMID: 38934627 DOI: 10.1093/ibd/izae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Despite the growing proportion of older adults with inflammatory bowel disease (IBD), their lived experience is not well understood. IBD literature is generally focused on younger adults, and few studies are qualitative. Older adults may report well-being differently than younger adults, so it is important that we learn about their goals and priorities with a chronic disease. OBJECTIVE The study sought to understand the lived experience of older adults with IBD and explore their perceptions and priorities. METHODS We conducted in-depth interviews with patients ≥60 years of age with IBD to evaluate the impact and perception of IBD in the context their overall health and life. We used a hybrid inductive-deductive thematic analysis of our transcripts to identify underlying patterns. RESULTS We achieved thematic saturation after 22 interviews. We produced 4 major themes: (1) having IBD at an older age, (2) financial ramifications of IBD at an older age, (3) expectations for a meaningful life, and (4) unmet needs. Prominent subthemes included (1) ageism, loss of autonomy, and barriers to healthcare; (2) retirement and insurance issues; (3) redefining quality of life and gratitude; and (4) social isolation and navigating daily life with IBD. CONCLUSIONS Having IBD later in life presents unique challenges. Physicians treating older patients should consider age-sensitive communication, susceptibility to social isolation, and practices for healthy aging in the context of IBD. Patient priorities for further investigation include more representation in the media and educational material tailored for older adults with IBD.
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Affiliation(s)
- Alison Rusher
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth Araka
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
- The Mongan Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christine Ritchie
- The Mongan Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Bharati Kochar
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
- The Mongan Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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2
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Nordestgaard RLM, Wewer MD, Malham M, Wewer V, Boysen T, Burisch J. Treatment of inflammatory bowel disease with steroid-sparing medications is age-dependent - Results from a Danish nationwide cohort study, 2000-2018. Aliment Pharmacol Ther 2024. [PMID: 38859674 DOI: 10.1111/apt.18106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/10/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Paediatric-onset and elderly-onset inflammatory bowel disease (IBD) present unique treatment challenges. AIMS We investigated treatment patterns following a first and second course of systemic steroids in paediatric- and elderly-onset IBD and compared them to adult-onset IBD. METHODS All patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 2000 and 2018 were identified through the Danish healthcare registries. Patients were divided into groups based on their age at diagnosis. Kaplan-Meier plots were prepared for medications and surgeries after diagnosis and after the first and second courses of systemic steroids. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using multivariate Cox regression analysis for steroid-sparing medications. RESULTS 1851 CD (13%) and 1687 (6%) UC patients were paediatric-onset, while 2952 (20%) CD and 5812 (23%) UC patients were elderly-onset. Paediatric-onset more frequently received immunomodulators [CD: HR: 1.64, CI: 1.52-1.77, UC: HR: 2.29, CI: 2.02-2.61] and biologics [CD: HR: 1.43, CI: 1.25-1.65, UC: HR: 1.27, CI: 0.99-1.64], while elderly-onset less frequently received immunomodulators [CD: HR: 0.39, CI: 0.35-0.44, UC: HR: 0.58, CI: 0.50-0.67] and biologics [CD: HR: 0.19, CI: 0.14-0.25, UC: HR: 0.36, CI: 0.27-0.48] compared to adult-onset age groups. After two courses of systemic steroids, elderly-onset still received less steroid-sparing medications. High frailty was associated with lower usage of medications for elderly-onset. CONCLUSION There are significant differences in the use of steroid-sparing medication between age of onset, even after two courses with systemic steroids. High frailty could account for some of these differences in elderly-onset IBD.
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Affiliation(s)
- Rie Louise Møller Nordestgaard
- Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Mads Damsgaard Wewer
- Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Mikkel Malham
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- The Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Departments of Epidemiology and Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Vibeke Wewer
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- The Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Trine Boysen
- Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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3
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Anisdahl K, Lirhus SS, Medhus AW, Moum B, Melberg HO, Høivik ML. Frailty risk and treatment strategy in elderly-onset inflammatory bowel disease. A Norwegian nationwide population-based registry study. Dig Liver Dis 2024:S1590-8658(24)00262-7. [PMID: 38433021 DOI: 10.1016/j.dld.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/21/2024] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND/AIMS To determine real-world medical and surgical treatment patterns in elderly-onset inflammatory bowel disease in a nationwide cohort, and to investigate associations between frailty and treatment choices. METHODS Norwegian health registries were used to identify adult-onset (born 1950-1989) and elderly-onset (born 1910-1949) patients with Crohn's disease (CD) and ulcerative colitis (UC) diagnosed 2010-2017 (n = 13,006). Patients were classified as no, low and intermediate/high frailty risk after the Hospital Frailty Risk Score. Outcomes included use of medical and surgical treatment. RESULTS Within five years, elderly-onset patients received less biologics (13% [CD], 7% [UC]) and immunomodulators (24% [CD], 11% [UC]), and major surgery was more frequent (22% [CD], 9% [UC]) than in adult-onset. Respective log rank tests were significant (p < 0.01). Compared to no frailty risk groups, elderly-onset UC with intermediate/high frailty risk had lower probability of starting biologics (4% versus 9%), immunomodulators (7% versus 13%) and 5-aminosalisylic acids (66% versus 84%), and elderly-onset CD with intermediate/high frailty risk had higher probability of starting prednisolone (67% versus 49%). Respective log rank tests were significant (p < 0.05). CONCLUSIONS Elderly-onset patients received less biologics and immunomodulators and a larger proportion underwent major surgery. Frailty risk in elderly-onset patients was associated with increased use of prednisolone, and less use of 5-aminosalisylic acids, immunomodulators and biologics.
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Affiliation(s)
- Karoline Anisdahl
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Sandre Svatun Lirhus
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Asle W Medhus
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Moum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Gastroenterology, Østfold Hospital Trust, Viken, Norway
| | - Hans Olav Melberg
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway; Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ingrasciotta Y, Grova M, Crispino F, Isgrò V, Calapai F, Macaluso FS, Mattace-Raso F, Trifirò G, Orlando A. Safety and potential interaction of immunosuppressive drugs for the treatment of inflammatory bowel disease in elderly patients. Minerva Gastroenterol (Torino) 2024; 70:98-108. [PMID: 34057333 DOI: 10.23736/s2724-5985.21.02919-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, are chronic diseases associated with increased morbidity and reduced quality of life. Age may represent a risk factor for adverse events, due to the multimorbidity and polypharmacy, common in elderly patients. Elderly are often not included in clinical trials evaluating efficacy and safety of study drugs for the treatment of inflammatory bowel diseases. Several drugs, such as aminosalicylates, systemic corticosteroids, immunosuppressant drugs, biological drugs and Janus Kinase inhibitors, are available for the management of inflammatory bowel diseases. Therefore, with the increasing spectrum of therapeutic options it is important to analyze the evidence regarding the safety of the use of these agents in elderly patients. Selection of immunosuppressive therapy is a challenge in the management of elderly patients with inflammatory bowel diseases, for whom biologics with a lower risk of infection or cancer, such as vedolizumab and ustekinumab, may be preferred in elderly patients. Concomitant therapies and comorbidities must be thoroughly investigated before initiating any immunosuppressive or biological therapy in order to minimize the risk of drug-drug interactions. This review aimed to provide an overview of the safety of thiopurines, methotrexate and target therapies as well as their drug-drug interactions in patients with inflammatory bowel diseases.
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Affiliation(s)
- Ylenia Ingrasciotta
- Department of Internal Medicine, Erasmus MC University-Medical Center, Rotterdam, the Netherlands -
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy -
| | - Mauro Grova
- Unit of Inflammatory Bowel Disease, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
- Section of Gastroenterology and Hepatology, Internal Medicine and Medical Specialties, Department of Health Promotion Sciences Maternal and Infant Care (PROMISE), University of Palermo, Palermo, Italy
| | - Federica Crispino
- Unit of Inflammatory Bowel Disease, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
- Section of Gastroenterology and Hepatology, Internal Medicine and Medical Specialties, Department of Health Promotion Sciences Maternal and Infant Care (PROMISE), University of Palermo, Palermo, Italy
| | - Valentina Isgrò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fabrizio Calapai
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Fabio S Macaluso
- Unit of Inflammatory Bowel Disease, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus MC University-Medical Center, Rotterdam, the Netherlands
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ambrogio Orlando
- Unit of Inflammatory Bowel Disease, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
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5
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Viola A, Fiorino G, Costantino G, Fries W. Epidemiology and clinical course of late onset inflammatory bowel disease. Minerva Gastroenterol (Torino) 2024; 70:52-58. [PMID: 34057332 DOI: 10.23736/s2724-5985.21.02890-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With the increasing age of the general population in developed countries, the management of several chronic diseases becomes more and more complex due to comorbidities. Some, especially inflammatory bowel diseases, formerly believed to belong to the young adult population, have now been recognized as being present at disease onset also in the ageing population, representing medical challenges different from those in the younger population. In the past few years, knowledge on this special older population has increased, changing initial beliefs concerning epidemiology and course of disease. In the present review, we addressed the most recent evidence concerning their current incidence compared with other age groups, their clinical course, potential risk factors for the development of late-onset IBDs, associated diseases, and cancer risk beyond therapy-related neoplasias.
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Affiliation(s)
- Anna Viola
- Gastroenterology and Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy -
| | - Gionata Fiorino
- Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Costantino
- Gastroenterology and Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Walter Fries
- Gastroenterology and Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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6
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Li A, Coote M, Thin L. Prevalence and risk factors for early medical and surgical complications following an admission for acute severe ulcerative colitis. Therap Adv Gastroenterol 2023; 16:17562848231215148. [PMID: 38059014 PMCID: PMC10697038 DOI: 10.1177/17562848231215148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/02/2023] [Indexed: 12/08/2023] Open
Abstract
Background Risk factors for colectomy following an episode of acute severe ulcerative colitis (ASUC) have been well studied, but data examining the early complications following an episode is limited. Objectives We aimed to evaluate the prevalence and risk factors for medical and surgical complications within 90 days of an ASUC admission and determine if a high-intensity induction infliximab dose is associated with these complications. Design Retrospective analysis. Methods We conducted a retrospective study of ASUC admissions between January 2015 and July 2021 at a tertiary hospital. The primary outcome was the prevalence of total, medical and surgical complications within 90 days following an ASUC admission. Multivariate linear regression analysis assessed for factors associated with the prevalence of complications. Results A total of 150 patients had 186 hospital admissions for ASUC. In total, 101/186 (54.3%) admissions required rescue medical therapy. Standard infliximab induction occurred in 65/100 admissions, accelerated infliximab induction in 35/100 and cyclosporine in 1/100 of admissions. In total, 117 complications, including 74/117 (63.2%) medical and 43/117 (36.8%) surgical complications, arose. Low serum albumin was independently associated with a higher incidence of total [β = -0.08 (95% confidence interval (CI): -0.15, -0.01), p = 0.03] and surgical complications [β = -0.1 (95% CI: -0.18, -0.001), p = 0.047], while an increased age was associated with increased incidence of surgical complications [β = 0.06 (95% CI: 0.01, 0.12), p = 0.02]. A higher Charlson score was associated with increased medical complications [β = 0.12 (95% CI: 0.01, 0.24), p = 0.03]. Infliximab induction dose intensity was not associated with an increased incidence of any complications. Conclusion Early complications following an ASUC admission is prevalent although the majority are not serious. Risk factors associated with complications include low serum albumin, older age and a higher comorbidity score. Induction infliximab dose intensity, however, is not a risk factor.
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Affiliation(s)
- Angel Li
- Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Matthew Coote
- Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Lena Thin
- Department of Internal Medicine, University of Western Australia, Medical School, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
- Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, WA, Australia
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7
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Garg R, Aggarwal M, Mohammed A, Achkar JP, Lashner B, Philpott J, Cohen B, Qazi T, Rieder F, Regueiro M, Click B. Real-world effectiveness and safety of ustekinumab and vedolizumab in elderly patients with Crohn's disease. Indian J Gastroenterol 2023; 42:718-723. [PMID: 37523059 PMCID: PMC10993992 DOI: 10.1007/s12664-023-01391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/09/2023] [Indexed: 08/01/2023]
Abstract
Studies report favorable efficacy and safety profiles of ustekinumab (UST) and vedolizumab (VDZ) in Crohn's disease (CD), but effectiveness and safety data in elderly patients with CD is lacking. We retrospectively analyzed 78 elderly patients (39 each UST and VDZ) and found that patients on UST and VDZ experienced similar rates of clinical response, remission and mucosal healing despite high proportion of prior biologic exposure. Both UST and VDZ appear to be effective and safe in this at-risk CD population. Further large studies are needed to validate our findings.
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Affiliation(s)
- Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Manik Aggarwal
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Abdul Mohammed
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Jean Paul Achkar
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bret Lashner
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jessica Philpott
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Cohen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Taha Qazi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Click
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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8
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Vosoghinia H, Saberzadeh-Ardestani B, Anushiravani A, Mansour-Ghanaei F, Fakheri H, Vahedi H, Sheikhesmaeili F, Yazdanbod A, Moosavy SH, Maleki I, Nasseri-Moghaddam S, Khosravi B, Malekzadeh M, Kasaeian A, Alatab S, Sadeghi A, Kolahdoozan S, Amani M, Saberhosseini SN, Rayatpisheh M, Ahadi M, Colombel JF, Ungaro RC, Sima AR, Malekzadeh R. Comparison of Disease Phenotype and Course among Elderly- and Early-Onset Inflammatory Bowel Diseases in the Middle East. ARCHIVES OF IRANIAN MEDICINE 2023; 26:481-488. [PMID: 38310403 PMCID: PMC10862057 DOI: 10.34172/aim.2023.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/03/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND It is unknown if the clinical manifestations and phenotype of disease are comparable between early- and elderly-onset inflammatory bowel disease (IBD). We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients. METHODS This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) compared demographics, disease phenotype, disease activity, IBD-related surgery and medications between early- and elderly-onset IBD. A generalized linear regression model was used to investigate the relative risk of age at diagnosis adjusted for gender and disease duration for the outcomes. RESULTS From 10048 IBD patients, 749 with early-onset (7.5%), and 472 (4.7%) elderly-onset IBD were enrolled: 855 (63.1%) ulcerative colitis (UC) and 366 (26.9%) Crohn's disease (CD). Left-sided colitis was more frequent among elderly-onset UC patients (P<0.001). Ileum and ileocolonic locations were the most common types in elderly-onset and early-onset CD patients, respectively. In comparison with elderly-onset UC, early-onset cases more often used prednisolone (22.1% vs. 11.4%, P=0.001), immunomodulators (44.9% vs 25.2%, P<0.001) and anti-tumor necrosis factors (TNF) (20.1% vs 11.9%, P=0.002). Elderly-onset UC patients had 0.7 times lower risk of aggressive phenotype (95%CI:0.6‒0.9, P=0.005). Early-onset CD was associated with higher use of prednisolone (27.7% vs 8.1%, P<0.001), immunomodulators (58.7% vs 41.8%, P=0.005) and anti-TNF (49.6% vs 35.4%, P=0.006). CONCLUSION Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use.
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Affiliation(s)
- Hasan Vosoghinia
- Gastroenterology and Hepatology Department, Faculty of Medicine, Ghaem Hospital, Mashhad, Iran
| | - Bahar Saberzadeh-Ardestani
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Anushiravani
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hafez Fakheri
- Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Homayoon Vahedi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sheikhesmaeili
- Liver and Digestive Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Abbas Yazdanbod
- Gastroenterology and Hepatology Department, Digestive Diseases Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Seyed Hamid Moosavy
- Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Iradj Maleki
- Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavosh Nasseri-Moghaddam
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Khosravi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sudabeh Alatab
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Sadeghi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Kolahdoozan
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amani
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Rayatpisheh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Ahadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jean-Frederic Colombel
- The Henry D. Janowitz Division of Gastroenterology Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ryan C. Ungaro
- The Henry D. Janowitz Division of Gastroenterology Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ali Reza Sima
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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9
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Shaffer SR, Kuenzig ME, Windsor JW, Bitton A, Jones JL, Lee K, Murthy SK, Targownik LE, Peña-Sánchez JN, Rohatinsky N, Ghandeharian S, Tandon P, St-Pierre J, Natt N, Davis T, Weinstein J, Im JHB, Benchimol EI, Kaplan GG, Goddard Q, Gorospe J, Bergevin M, Silver K, Bowles D, Stewart M, Pearlstein M, Dawson EH, Bernstein CN. The 2023 Impact of Inflammatory Bowel Disease in Canada: Special Populations-IBD in Seniors. J Can Assoc Gastroenterol 2023; 6:S45-S54. [PMID: 37674503 PMCID: PMC10478801 DOI: 10.1093/jcag/gwad013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Approximately one out of every 88 seniors has inflammatory bowel disease (IBD), and this is expected to increase in the future. They are more likely to have left-sided disease in ulcerative colitis, and isolated colonic disease in Crohn's disease; perianal disease is less common. Other common diagnoses in the elderly must also be considered when they initially present to a healthcare provider. Treatment of the elderly is similar to younger persons with IBD, though considerations of the increased risk of infections and malignancy must be considered when using immune modulating drugs. Whether anti-TNF therapies increase the risk of infections is not definitive, though newer biologics, including vedolizumab and ustekinumab, are thought to be safer with lower risk of adverse events. Polypharmacy and frailty are other considerations in the elderly when choosing a treatment, as frailty is associated with worse outcomes. Costs for IBD-related hospitalizations are higher in the elderly compared with younger persons. When elderly persons with IBD are cared for by a gastroenterologist, their outcomes tend to be better. However, as elderly persons with IBD continue to age, they may not have access to the same care as younger people with IBD due to deficiencies in their ability to use or access technology.
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Affiliation(s)
- Seth R Shaffer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Parul Tandon
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Joëlle St-Pierre
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Navneet Natt
- Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maxime Bergevin
- École de kinésiologie et des sciences de l’activité physique, Faculté de médecine, Université́ de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | - Ken Silver
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Dawna Bowles
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | | | | | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
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10
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Bedard K, Taylor L, Rajabali N, Kroeker K, Halloran B, Meng G, Raman M, Tandon P, Abraldes JG, Peerani F. Handgrip strength and risk of malnutrition are associated with an increased risk of hospitalizations in inflammatory bowel disease patients. Therap Adv Gastroenterol 2023; 16:17562848231194395. [PMID: 37667803 PMCID: PMC10475242 DOI: 10.1177/17562848231194395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 09/06/2023] Open
Abstract
Background In patients with inflammatory bowel disease (IBD), frailty is independently associated with mortality and morbidity. Objectives This study aimed to extend this work to determine the association between the clinical frailty scale (CFS), handgrip strength (HGS), and malnutrition with IBD-related hospitalizations and surgeries. Design IBD patients ⩾18 years of age were prospectively enrolled from two ambulatory care clinics in Alberta, Canada. Methods Frailty was defined as a CFS score ⩾4, dynapenia as HGS < 16 kg for females and <27 kg for males, malnutrition using the subjective global assessment (SGA), and the risk of malnutrition using either the abridged patient-generated SGA (abPG-SGA), or the Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NRT). Logarithm relative hazard graphs and multivariable logistic regression models adjusting for relevant confounders were constructed. Results One hundred sixty-one patients (35% ulcerative colitis, 65% Crohn's disease) with a mean age of 42.2 (±15.9) years were followed over a mean period of 43.9 (±10.1) months. Twenty-seven patients were hospitalized, and 13 patients underwent IBD-related surgeries following baseline. While the CFS (aHR 1.34; p = 0.61) and SGA (aHR 0.81; p = 0.69) did not independently predict IBD-related hospitalizations, decreased HGS (aHR 3.96; p = 0.03), increased abPG-SGA score (aHR 1.07; p = 0.03) and a SaskIBD-NRT ⩾ 5 (aHR 4.49; p = 0.02) did. No variable was independently associated with IBD-related surgeries. Conclusion HGS, the abPG-SGA, and the SaskIBD-NRT were independently associated with an increased risk of IBD-related hospitalizations. Future studies should aim to validate other frailty assessments in the IBD population in order to better tailor care for all IBD patients.
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Affiliation(s)
- Katherine Bedard
- Department of Medicine, Faculty of Graduate Studies and Research, University of Alberta, Edmonton, AB, Canada
| | - Lorian Taylor
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Naheed Rajabali
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Brendan Halloran
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Guanmin Meng
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Puneeta Tandon
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Juan G. Abraldes
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Farhad Peerani
- Division of Gastroenterology, University of Alberta, 1-59 Zeidler Ledcor Centre, 8540 – 112 Street NW, Edmonton AB T6G 2P8, Canada
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11
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Meng G, Monaghan TM, Duggal NA, Tighe P, Peerani F. Microbial-Immune Crosstalk in Elderly-Onset Inflammatory Bowel Disease: Unchartered Territory. J Crohns Colitis 2023; 17:1309-1325. [PMID: 36806917 DOI: 10.1093/ecco-jcc/jjad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Indexed: 02/23/2023]
Abstract
Elderly-onset inflammatory bowel disease [IBD] patients exhibit a distinct natural history compared to younger IBD patients, with unique disease phenotypes, differential responses to therapy, and increased surgical morbidity and mortality. Despite the foreseeable high demand for personalized medicine and specialized IBD care in the elderly, current paradigms of IBD management fail to capture the required nuances of care for elderly-onset IBD patients. Our review postulates the roles of systemic and mucosal immunosenescence, inflammageing and a dysbiotic microbial ecosystem in the pathophysiology of elderly-onset IBD. Ultimately, a better understanding of elderly-onset IBD can lead to improved patient outcomes and the tailoring of future preventative and treatment strategies.
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Affiliation(s)
- Guanmin Meng
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tanya M Monaghan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Niharika A Duggal
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Paddy Tighe
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Farhad Peerani
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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12
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Sousa P, Bertani L, Rodrigues C. Management of inflammatory bowel disease in the elderly: A review. Dig Liver Dis 2023; 55:1001-1009. [PMID: 36681569 DOI: 10.1016/j.dld.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/23/2023]
Abstract
The burden of Inflammatory Bowel Disease (IBD) is increasing worldwide, with a particular increase in the prevalence in the elderly population, due to the ageing of young-onset IBD as well as to the increasing incidence in elderly patients. Elderly IBD patients present specific challenges to the treating physician, as they have comorbidities, lower functional reserves, and higher risk of treatment-related complications. The diagnosis of IBD in the elderly may be difficult due to a more subtle disease presentation and to a wide range of differential diagnosis. Moreover, as these patients are often excluded from clinical trials, there is a lack of high-quality evidence to inform on the most appropriate management. Despite an increasing prevalence, the management of IBD in the elderly is still hindered by frequent misconceptions by physicians treating these patients. Due to a erroneous notion of a milder disease course and fear of adverse events, elderly IBD-patients are managed with frequent and continuous use of steroids and undertreated with effective medical therapies. In this review, we describe the principles of management of IBD in the elderly, which is a topic of increasing importance to IBD clinics, that will have to progressively adapt to care for an ageing population.
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Affiliation(s)
- Paula Sousa
- Department of Gastroenterology, Viseu Unit, Tondela-Viseu Hospital Centre, Viseu 3504-509, Portugal.
| | - Lorenzo Bertani
- Department of General Surgery and Gastroenterology, Tuscany North West ASL, Pontedera Hospital, Pontedera, Italy
| | - Cláudio Rodrigues
- Department of Gastroenterology, Viseu Unit, Tondela-Viseu Hospital Centre, Viseu 3504-509, Portugal
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13
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Sharip MT, Subramanian S. IBD in the elderly - beware of pitfalls! Saudi J Gastroenterol 2023; 29:201-203. [PMID: 37470664 PMCID: PMC10445498 DOI: 10.4103/sjg.sjg_185_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Mohmmed T. Sharip
- Department of Gastroenterology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Sreedhar Subramanian
- Department of Gastroenterology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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14
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Rohatinsky N, Cave J, Fowler S, Risling T, Peña-Sánchez JN. An Exploratory Study of Health-related Quality of Life and Care Experiences in Older Adults with Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2023; 6:116-124. [PMID: 37273969 PMCID: PMC10235589 DOI: 10.1093/jcag/gwac039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
Canada has one of the highest rates of inflammatory bowel disease (IBD), with older adults as the fastest-growing group of individuals affected. This exploratory mixed methods study aimed to understand perceived health-related quality of life and care experiences in older adults with IBD. Participants greater than 60 years of age, who were diagnosed with IBD, and who lived in Saskatchewan, Canada were invited to participate in both an online survey and telephone interview. Seventy-three respondents completed the survey, and 18 participants were interviewed. Most individuals were diagnosed before age 60, believed their IBD was well controlled, believed their current treatment was useful, and were satisfied with their care. Individuals also reported a moderate health-related quality of life. However, collaborative management of IBD care between providers and older adults with IBD was identified as an area with room for improvement. Strategies to enhance disease self-management and engaged chronic illness care are critical.
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Affiliation(s)
- Noelle Rohatinsky
- Correspondence: Noelle Rohatinsky, PhD, RN, College of Nursing, University of Saskatchewan, 4342-104 Clinic Place, Saskatoon, Saskatchewan S7N 2E5, Canada, e-mail:
| | - Janelle Cave
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sharyle Fowler
- College of Medicine, Gastroenterology and Hepatology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tracie Risling
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Juan Nicolás Peña-Sánchez
- College of Medicine, Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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15
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Singh S, Boland BS, Jess T, Moore AA. Management of inflammatory bowel diseases in older adults. Lancet Gastroenterol Hepatol 2023; 8:368-382. [PMID: 36669515 DOI: 10.1016/s2468-1253(22)00358-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 01/19/2023]
Abstract
The burden of inflammatory bowel disease (IBD) in older adults (ie, aged over 60 years old) is increasing due to a combination of an ageing population with compounding prevalence of IBD and increasing incidence of elderly-onset (ie, onset over the age of 60 years) IBD. Despite the increasing prevalence of IBD, there is a paucity of evidence on which to base management of older adults with IBD, leading to substantial variability in care. This population is under-represented in clinical trials and has a high burden of chronic corticosteroid use, low uptake of steroid-sparing immunosuppressive agents, and high rates of unplanned health-care use and disability. Management of IBD in older adults requires carefully weighing an individual patient's risk of IBD-related complications, IBD-directed immunosuppressive therapy, and non-IBD comorbidities. A deeper understanding of biological and functional age, dynamic risk stratification strategies (including frailty-based risk assessment tools), comparative effectiveness and safety of current therapies and treatment strategies, and shared decision making to inform treatment goals and targets is needed to improve outcomes in older adults with IBD. In this Review, we discuss the epidemiology, natural history, pathophysiology, and medical and surgical management of older individuals living with IBD and identify key research gaps and approaches to address them.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Brigid S Boland
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark; Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Alison A Moore
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA
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16
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Bozon A, Nancey S, Serrero M, Caillo L, Gilletta C, Benezech A, Combes R, Danan G, Akouete S, Pages L, Bourgaux JF, Cosquer GL, Boivineau L, Meszaros M, Altwegg R. Risk of Infection in Elderly Patients with Inflammatory Bowel Disease under biologics: A Prospective, Multicenter, Observational, One-Year follow-up comparative study. Clin Res Hepatol Gastroenterol 2023; 47:102107. [PMID: 36906225 DOI: 10.1016/j.clinre.2023.102107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES The emergence of biologics has improved the course of inflammatory bowel diseases (IBD) in the elderly population despite a potential higher risk of infections. We conducted a one-year, prospective, multicenter, observational study to determine the frequency of occurrence of at least one infectious event in elderly IBD patients under anti-TNF therapy compared with that in elderly patients under vedolizumab or ustekinumab therapies . METHODS All IBD patients over 65 years exposed to anti-TNF, vedolizumab or ustekinumab therapies were included. The primary endpoint was the prevalence of at least one infection during the whole one year follow-up. RESULTS Among the 207 consecutive elderly IBD patients prospectively enrolled, 113 were treated with anti-TNF and 94 with vedolizumab (n=63) or ustekinumab (n=31) (median age 71 years, 112 Crohn's disease). The Charlson index was similar between patients under anti-TNF and those under vedolizumab or ustekinumab as well as the proportion of patients under combination therapy and under concomitant steroid therapy did not differ between both both groups. The prevalence of infections was similar in patients under anti-TNF and in those under vedolizumab or ustekinumab (29% versus 28%, respectively; p=0.81). There was no difference in terms of type and severity of infection and of infection-related hospitalization rate. In multivariate regression analysis, only the Charlson comorbidity index (≥ 1) was identified as a significant and independent risk factor of infection (p=0.03). CONCLUSION Around 30 % of elderly patients with IBD under biologics experienced at least one infection during the one-year study follow-up period. The risk of occurrence of infection does not differ between anti-TNF and vedolizumab or ustekinumab therapies, and only the associated comorbidity was linked with the risk of infection.
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Affiliation(s)
- Anne Bozon
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud University Hospital, Hospices Civils de Lyon and INSERMU1111-CIRI, Lyon, France
| | - Mélanie Serrero
- Department of Gastroenterology, Marseille Nord Hospital, APHM, Marseille, France
| | - Ludovic Caillo
- Department of Gastroenterology, University Hospital of Nîmes, Nîmes, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Alban Benezech
- Department of Gastroenterology, Henri Duffaut Hospital, Avignon, France
| | - Roman Combes
- Department of Gastroenterology, Languedoc Gastroentérologie, Montpellier, France
| | - Guillaume Danan
- Department of Gastroenterology, Gastrodoc, Montpellier, France
| | - Sandrine Akouete
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier, France
| | - Laurence Pages
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier, France
| | | | | | - Lucile Boivineau
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Magdalena Meszaros
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Romain Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France.
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17
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Castillo-Regalado E, Ríos R, Aràjol C, Gely C, Márquez L, Calafat M, González-Muñoza C, Cañete F, Mesonero F, Guardiola J, Garcia-Planella E, Mañosa M, Domènech E. Clinical and endoscopic outcomes of patients with colonic Crohn's disease treated with 5-aminosalicylates as monotherapy. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:164-170. [PMID: 36179946 DOI: 10.1016/j.gastrohep.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND In spite of the lack of evidence regarding the clinical benefits of oral 5-aminosalicylic acid (5-ASA) compounds in Crohn's disease (CD), these drugs are frequently used in daily clinical practice, particularly for colonic CD. Our aim is to assess the use and clinical outcomes of 5-ASA of those patients with colonic CD treated with 5-ASA as monotherapy. METHODS Patients diagnosed with isolated colonic CD and treated with 5-ASA but never exposed to immunosuppressants or biologicals were identified from the local databases of five referral centres. A retrospective review of clinical and endoscopic outcomes was performed. RESULTS Out of 545 patients with isolated colonic CD, 106 (19%) were treated with oral 5-ASA in monotherapy as maintenance therapy. The median follow-up was 144 months (interquartile range [IQR], 48-234). Almost all of the patients (92%) presented an inflammatory pattern and 11% developed perianal disease. Half of the patients had already received 5-ASA at diagnosis, and the median duration of 5-ASA treatment was 107 months (IQR 22.5-187). Endoscopic remission, as defined by the absence of ulcers at the last complete colonoscopy, was observed in 65% of those patients undergoing at least one colonoscopy during follow-up. Male gender and extraintestinal manifestations were associated with a lower likelihood of achieving endoscopic remission. Nine patients required colectomy, but mostly soon after CD diagnosis. CONCLUSIONS 5-ASA seems to be of benefit in the long-term in one fifth of patients with colonic CD as the only maintenance therapy and should be considered in fragile patients with Crohn's colitis.
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Affiliation(s)
- Edgar Castillo-Regalado
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Raquel Ríos
- Department of Gastroenterology, Hospital Ramón y Cajal, Madrid, Spain
| | - Clàudia Aràjol
- Department of Gastroenterology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Cristina Gely
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Lucía Márquez
- Department of Gastroenterology, Hospital del Mar, Barcelona, Catalonia, Spain
| | - Margalida Calafat
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Carlos González-Muñoza
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Fiorella Cañete
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - Jordi Guardiola
- Department of Gastroenterology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Esther Garcia-Planella
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Míriam Mañosa
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Eugeni Domènech
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
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18
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Dawra S, Behl P, Srivastava S, Manrai M, Chandra A, Kumar A, Kumar A, Tevatia MS. Non-neoplastic disorders in an aging gut: concise review. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023. [DOI: 10.1186/s43162-023-00189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
AbstractThe spectrum of gastrointestinal (GI) issues in the older population varies from common physiological age-related changes to devastating, less common sinister pathological illness. GI system has direct exposure to external environment. Thus, it is modeled to embrace the pathophysiological changes that occur due to interaction with external factors. Gastrointestinal tract (GIT) per se is more resilient to aging as compared to other organ systems. On the other hand, elderly may present with a large plethora of GI symptoms. This presents a challenge to all echelons of medical consultation for accurate attribution for the aging process or pathophysiological causation of GI symptoms. This dichotomy leads to hindrance in adequate and appropriate treatment of GI ailments. In GI system, non-neoplastic disorders are far more common than neoplastic disorders. Hence, it becomes imperative to understand the aging evolution of the GI system and management of GI disorders in the older population.
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Casas-Deza D, Lamuela-Calvo LJ, Gomollón F, Arbonés-Mainar JM, Caballol B, Gisbert JP, Rivero M, Sánchez-Rodríguez E, Arias García L, Gutiérrez Casbas A, Merino O, Márquez L, Laredo V, Martín-Arranz MD, López Serrano P, Riestra Menéndez S, González-Muñoza C, de Castro Parga L, Calvo Moya M, Fuentes-Valenzuela E, Esteve M, Iborra M, Dura Gil M, Barreiro-De Acosta M, Lorente-Poyatos RH, Manceñido N, Calafat M, Rodríguez-Lago I, Guardiola Capo J, Payeras MA, Morales Alvarado VJ, Tardillo C, Bujanda L, Muñoz-Nuñez JF, Ber Nieto Y, Bermejo F, Almela P, Navarro-Llavat M, Martínez Montiel P, Rodríguez Gutiérrez C, Van Domselaar M, Sesé E, Martínez Pérez T, Ricart E, Chaparro M, García MJ, López-Sanromán A, Sicilia B, Orts B, López-García A, Martín-Arranz E, Pérez-Calle JL, de Francisco R, García-Planella E, Domènech E, García-López YS. Effectiveness and Safety of Ustekinumab in Elderly Patients with Crohn's Disease: Real World Evidence From the ENEIDA Registry. J Crohns Colitis 2023; 17:83-91. [PMID: 35913456 DOI: 10.1093/ecco-jcc/jjac108] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS Clinical trials and real-life studies with ustekinumab in Crohn's disease [CD] have revealed a good efficacy and safety profile. However, these data are scarcely available in elderly patients. Therefore, we aim to assess the effectiveness and safety of ustekinumab in elderly patients with CD. METHODS Elderly patients [>60 years old] from the prospectively maintained ENEIDA registry treated with ustekinumab due to CD were included. Every patient was matched with two controls under 60 years of age, according to anti-tumour necrosis factor use and smoking habit. Values for the Harvey-Bradshaw Index [HBI], endoscopic activity, C-reactive protein [CRP] and faecal calprotectin [FC] were recorded at baseline and at weeks 16, 32 and 54. RESULTS In total, 648 patients were included, 212 of whom were elderly. Effectiveness was similar between young and elderly patients during the follow-up. Steroid-free remission was similar at week 16 [54.6 vs 51.4%, p = 0.20], 32 [53.0% vs 54.5%, p = 0.26] and 54 [57.8% vs 51.1%, p = 0.21]. Persistence of ustekinumab as maintenance therapy was similar in both age groups [log-rank test; p = 0.91]. There was no difference in the rate of adverse effects [14.2% vs 11.2%, p = 0.350], including severe infections [7.1% vs 7.3%, p = 1.00], except for the occurrence of de novo neoplasms, which was higher in older patients [0.7% vs 4.3%, p = 0.003]. CONCLUSIONS Ustekinumab is as effective in elderly patients with CD as it is in non-elderly patients. The safety profile also seems to be similar except for a higher rate of de novo neoplasms, probably related to the age of the elderly patients.
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Affiliation(s)
- Diego Casas-Deza
- Gastroenterology Department, University Hospital Miguel Servet, Zaragoza, Spain.,Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Luis Javier Lamuela-Calvo
- Gastroenterology Department, University Hospital Miguel Servet, Zaragoza, Spain.,Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Fernando Gomollón
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Gastroenterology Department, University Hospital Lozano Blesa, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - José Miguel Arbonés-Mainar
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Instituto Aragonés de Ciencias de la Salud (IACS), Instituto de Investigación Sanitaria (IIS) de Aragón, Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Berta Caballol
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Montserrat Rivero
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación IDIVAL Santander, Spain
| | | | - Lara Arias García
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Ana Gutiérrez Casbas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital General de Alicante, Alicante, Spain
| | - Olga Merino
- Gastroenterology Department, Hospital Universitario de Cruces, Baracaldo, Spain
| | - Lucía Márquez
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
| | - Viviana Laredo
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Gastroenterology Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - María Dolores Martín-Arranz
- Department of Gastroenterology of La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid, Hospital La Paz Institute for Health Research, La Paz Hospital, Madrid, Spain
| | - Pilar López Serrano
- Gastroenterology Department, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain
| | - Sabino Riestra Menéndez
- Gastroenterology Department, University Hospital Central de Asturias, and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
| | | | - Luisa de Castro Parga
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Marta Calvo Moya
- Gastroenterology Department, Hospital Universitario Puerto de Hierro, Madrid, Spain
| | | | - Maria Esteve
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Mútua de Terrasa, Terrasa, Spain
| | - Marisa Iborra
- Gastroenterology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Miguel Dura Gil
- Gastroenterology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Noemí Manceñido
- Gastroenterology Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain
| | - Margalida Calafat
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | - Jordi Guardiola Capo
- Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | - Carlos Tardillo
- Gastroenterology department, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | | | | | - Fernando Bermejo
- Gastroenterology Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Pedro Almela
- Gastroenterology Department, Hospital General de Castelló, Castellón, Spain
| | | | | | | | | | - Eva Sesé
- Gastroenterology Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | - Elena Ricart
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - María José García
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación IDIVAL Santander, Spain
| | | | - Beatriz Sicilia
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Beatriz Orts
- Clinical Pharmacology, ISABIAL, Hospital General Universitario de Alicante, Spain
| | | | - Eduardo Martín-Arranz
- Department of Gastroenterology of La Paz University Hospital. Hospital La Paz Institute for Health Research, La Paz Hospital, Madrid, Spain
| | | | - Ruth de Francisco
- Gastroenterology Department, University Hospital Central de Asturias, and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
| | | | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Y Santiago García-López
- Gastroenterology Department, University Hospital Miguel Servet, Zaragoza, Spain.,Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
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20
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Barnaba Durairaj MV, Jaleel R, Pulimood AB. Granulomatous inflammation is less common in delayed-onset Crohn's disease. Trop Doct 2023; 53:113-116. [PMID: 35903927 DOI: 10.1177/00494755221104645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Crohn's disease (CD) usually affects younger individuals but delayed-onset disease is not uncommon. We studied the epidemiology, demographic profile, and clinical characteristics of patients with delayed-onset CD (disease onset >50 years) and compared them with CD in younger individuals (disease onset 20-40 years) in a tertiary care center in India. The presenting symptoms, site of involvement, and treatment profile were similar, except for weight loss, which was more often noted in young-onset CD. However, granulomatous inflammation on mucosal biopsy was twice as common in young-onset compared to delayed-onset CD. As it is thus seen less often in delayed-onset CD, this may lead to a potential delay in diagnosis and treatment.
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Affiliation(s)
| | - Rajeeb Jaleel
- Department of Gastroenterology, 30025Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Anna B Pulimood
- Department of Pathology, 30025Christian Medical College & Hospital, Vellore, Tamil Nadu, India
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21
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Ustekinumab and Vedolizumab Are Equally Safe and Effective in Elderly Crohn's Disease Patients. Dig Dis Sci 2022; 68:1983-1994. [PMID: 36436155 PMCID: PMC9702964 DOI: 10.1007/s10620-022-07770-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anti-tumour necrosis factor (anti-TNF) agents are associated with increased infection risk among elderly inflammatory bowel disease (IBD) patients, and thus, alternative biologics may be preferable. However, little comparative data exist on the safety and efficacy of vedolizumab and ustekinumab in elderly IBD patients. AIMS To compare the safety and effectiveness of ustekinumab and vedolizumab in elderly Crohn's disease patients. METHODS Patients ≥ 60 years old who commenced ustekinumab or vedolizumab for Crohn's disease (CD) were included. Primary outcome was serious infections, defined as requiring hospitalisation. Efficacy was assessed by treatment persistence and clinical response rates. We appropriately adjusted for confounders using propensity score-matched analysis weighted by the inverse predicted probability of treatment weighing and performed a logistic regression analysis to assess factors associated with serious infections and treatment persistence. RESULTS Eighty-three patients commencing ustekinumab and 42 commencing vedolizumab therapy were included. In a propensity adjusted cohort, the rate of serious infection and treatment persistence were comparable between ustekinumab and vedolizumab. There was a significant reduction in HBI at 6 and 12 months compared to baseline in both groups. Male gender was positively associated with serious infection risk at 12 months, and penetrating disease behaviour was positively associated with 12-month treatment persistence. Baseline HBI score was negatively associated with 12-month treatment persistence. Cox regression analysis showed no overall difference in treatment discontinuation-free and serious infection-free survival by 12 months. CONCLUSIONS We observed comparable safety and effectiveness for ustekinumab and vedolizumab in treating elderly CD patients.
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22
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Kontola K, Oksanen P, Huhtala H, Jussila A. Increasing incidence of inflammatory bowel disease with greatest change among the elderly: a nationwide study in Finland, 2000-2020. J Crohns Colitis 2022; 17:706-711. [PMID: 36420953 DOI: 10.1093/ecco-jcc/jjac177] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS The incidence of inflammatory bowel disease (IBD) is stabilising in many western countries. Some still show increasing incidence. Our objective was to determine the latest trends in IBD incidence and prevalence in Finland and compare these among different age groups and between different geographical areas. METHODS We used a nationwide registry of the Social Insurance Institute of Finland to identify new IBD cases during the period 2000-2020. Crude, age-specific and age-standardised incidence rates were calculated. Prevalence was estimated using valid reimbursements from the same database in 2000-2020. RESULTS We identified 42,498 new IBD cases. The crude annual incidence increased in ulcerative colitis (UC) from 20 to 35 (IRR 1.03, CI 1.02-1.03), in Crohn's disease (CD) from 8 to 13 (IRR 1.02, CI 1.02-1.03) and in IBD overall from 28 to 48 per 100,000 person-years (IRR 1.02, CI 1.02-1.03). Men had higher incidence than women in UC, but in CD the incidence was equal. The incidence of IBD increased in all age groups, except for small children. The increase in both UC and CD was most marked among the elderly aged over 70. A north-south gradient was discernible. The crude prevalence of IBD increased from 376 to 972 per 100,000 (PRR 1.05, CI 1.05-1.05). CONCLUSIONS The incidence of IBD, UC and CD is increasing in Finland. The increase is most notable in the elderly. Current prevalence of IBD is 1%.
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Affiliation(s)
- Kristi Kontola
- Department of Internal Medicine, Hospital District of South Ostrobothnia, Finland
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Finland
| | - Airi Jussila
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland
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23
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Kim YS, Na MJ, Ye BD, Cheon JH, Im JP, Kim JS. Clinical Characteristics of Korean Patients with Elderly-Onset Crohn's Disease: Results from the Prospective CONNECT Study. Gut Liver 2022; 16:995-1000. [PMID: 36379905 PMCID: PMC9668494 DOI: 10.5009/gnl220350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/01/2022] [Accepted: 10/18/2022] [Indexed: 08/30/2023] Open
Abstract
The clinical course and prognosis of patients with elderly-onset Crohn's disease (CD) remain unclear. This study aimed to analyze the clinical characteristics and outcomes of elderly-onset CD patients from the prospective CONNECT study cohort, a nationwide, multicenter cohort study of patients with CD in Korea. Among a total of 1,175 patients in the prospective CONNECT study cohort, 94 patients (Montreal age A3) were included and divided into two groups according to their age at diagnosis: the elderly-onset group (diagnosed with CD after 60 years of age, n=26, 67.54±6.7 years) and late adult-onset group (diagnosed as CD at age 41 to 59 years, n=68, 48.06±5.1 years). The elderly-onset group was characterized by a lower Crohn's disease activity index at diagnosis (124.89±101.9 vs 189.55±128.6, p=0.023) and higher rates of previous anti-tuberculosis treatment (34.6% vs 4.4%, p<0.001) than the late adult-onset group. Compared with the late adult-onset group, the elderly-onset group showed a significantly less use of thiopurines (p=0.003), as well as anti-tumor necrosis factor-alpha agents (p=0.047). Additionally, the elderly-onset group was less likely to require bowel resection than the late adult-onset group (p=0.067), suggesting that elderly-onset CD patients in Korea appear to have more favorable clinical outcomes than late adult-onset CD patients.
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Affiliation(s)
- You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Min Jeong Na
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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24
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Fiske J, Liu E, Limdi JK, Conley TE, Townsend T, Davies M, Brockwell R, Baig D, Abdelbadiee S, Uney A, Liaros A, Gaba W, Smith PJ, Flanagan PK, Subramanian S. Safety and effectiveness of ustekinumab in elderly Crohn's disease patients. Eur J Gastroenterol Hepatol 2022; 34:1132-1139. [PMID: 36170682 DOI: 10.1097/meg.0000000000002436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Anti-tumour necrosis factor (TNF) agents are associated with increased infection risk among elderly IBD patients, but little is known about non anti-TNF biologics in this cohort. We examined the safety and effectiveness of ustekinumab in elderly Crohn's patients. METHODS This retrospective multi-centre cohort study included Crohn's patients ≥60-years old who commenced ustekinumab. We recorded Harvey-Bradshaw index (HBI), concomitant steroid therapy, treatment persistence and new infections or malignancies. Primary outcome was serious infections requiring hospitalisation. RESULTS Seventy patients were included, with median age of 68 years. 43 (61.4%) had prior anti-TNF exposure, and 15 (21.4%) vedolizumab. Median treatment duration was 12 months, totalling 84 patient-years. Nine serious infections were reported, incidence 106.7/1000 patient-years. Systemic steroids were associated with increased risk of serious infections [odds ratio (OR) 7.83, 95% confidence interval (CI): 1.44-44.32, P = 0.02]. There were 27 "non-serious" infections; 321.4/1000 patient-years. Charlson co-morbidity index (OR 1.49, 95% CI: 1.05-2.12, P = 0.03) and steroid exposure (OR 44.10, 95% CI: 1.75-1112.10, P = 0.02) increased non-serious infection risk (P < 0.05). Mean HBI improved from 8.13 to 4.64 at 6 months and 4.10 at last follow up (P < 0.0001). 12-month treatment persistence was 55.7% (N = 39); 34 (48.6%) were steroid-free. CONCLUSION Ustekinumab was safe and effective in a cohort of elderly Crohn's disease patients. Infections were mostly mild, not resulting in therapy discontinuation. Serious infection risk was comparable to previously reported rates with anti-TNF agents. Steroid exposure was associated with an increased serious infection risk.
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Affiliation(s)
- Joseph Fiske
- Department of Gastroenterology, Liverpool University Hospital NHS Foundation Trust, Liverpool
| | - Eleanor Liu
- Department of Gastroenterology, Pennine Acute Hospital NHS Trust
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospital NHS Trust
- Manchester Academic Health Sciences; Faculty of Medicine, Biology &Health, University of Manchester, Manchester
| | - Thomas E Conley
- Department of Gastroenterology, Liverpool University Hospital NHS Foundation Trust, Liverpool
| | - Tristan Townsend
- Department of Gastroenterology, Liverpool University Hospital NHS Foundation Trust, Liverpool
| | - Mike Davies
- Department of Gastroenterology, Arrowe Park Hospital, Wirral
| | | | - Daniyal Baig
- Department of Gastroenterology, Liverpool University Hospital NHS Foundation Trust, Liverpool
| | - Sherif Abdelbadiee
- Department of Gastroenterology, Liverpool University Hospital NHS Foundation Trust, Liverpool
| | - Anastasia Uney
- Department of Gastroenterology, Liverpool University Hospital NHS Foundation Trust, Liverpool
| | - Angela Liaros
- Department of Gastroenterology, Whiston Hospital, Whiston
| | - Waqas Gaba
- Department of Gastroenterology, Warrington Hospital, Warrington
| | - Philip J Smith
- Department of Gastroenterology, Liverpool University Hospital NHS Foundation Trust, Liverpool
| | - Paul K Flanagan
- Department of Gastroenterology, Liverpool University Hospital NHS Foundation Trust, Liverpool
| | - Sreedhar Subramanian
- Department of Gastroenterology, Liverpool University Hospital NHS Foundation Trust, Liverpool
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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25
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Everhov ÅH, Erichsen R, Järås J, Pedersen L, Halfvarson J, Askling J, Ekbom A, Ludvigsson JF, Toft Sørensen H, Olén O. Colorectal cancer in elderly-onset inflammatory bowel disease: a 1969-2017 Scandinavian register-based cohort study. Aliment Pharmacol Ther 2022; 56:1168-1182. [PMID: 35916190 PMCID: PMC9545052 DOI: 10.1111/apt.17175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/10/2022] [Accepted: 07/23/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Previous research indicates that the increased relative risk of colorectal cancer (CRC) in inflammatory bowel disease (IBD) is limited to young-onset IBD. AIM To estimate risks of incident CRC and death from CRC in elderly-onset IBD METHODS: Patients diagnosed with IBD at age ≥ 60 years between 1969 and 2017 were identified using Danish and Swedish National Patient Registers and histopathology data. We linked data to Cancer and Causes of Death Registers and used Cox regression to estimate hazard ratios (HRs) for CRC diagnosis and death compared to matched (by sex, age, and region) IBD-free individuals. RESULTS Among 7869 patients with Crohn's disease followed for 54,220 person-years, and 21,224 patients with ulcerative colitis (UC) followed for 142,635 person-years, 2.10% and 1.90% were diagnosed with CRC, compared to 2.26% and 2.34% of reference individuals (median follow-up 6 and 7 years). The incidence of CRC was elevated during the first year after IBD diagnosis: 4.36 (95% CI = 3.33-5.71) in Crohn's disease and 2.48 (95% CI = 2.03-3.02) in UC, but decreased after the first year of follow-up: 0.69 (95% CI = 0.56-0.86) and 0.78 (95% CI = 0.69-0.88). Once diagnosed with CRC, the risk of CRC death was similar for IBD patients and the general population. CONCLUSION The excess risk of CRC in elderly-onset IBD was probably due to bias and not observed beyond the first year. From 2010, the HR for CRC diagnosis more than 1 year after initial IBD diagnosis was lower than in the largely unscreened reference population, supporting the benefit of endoscopic screening and surveillance in patients with IBD.
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Affiliation(s)
- Åsa H. Everhov
- Department of Clinical Science and Education SödersjukhusetKarolinska InstitutetStockholmSweden
- Clinical Epidemiology Division, Department of MedicineSolna Karolinska InstitutetStockholmSweden
| | - Rune Erichsen
- Department of Clinical EpidemiologyAarhus University Hospital and Aarhus UniversityAarhusDenmark
- Department of SurgeryRanders Regional HospitalRandersDenmark
| | - Jacob Järås
- Clinical Epidemiology Division, Department of MedicineSolna Karolinska InstitutetStockholmSweden
| | - Lars Pedersen
- Department of Clinical EpidemiologyAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of MedicineSolna Karolinska InstitutetStockholmSweden
| | - Anders Ekbom
- Clinical Epidemiology Division, Department of MedicineSolna Karolinska InstitutetStockholmSweden
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of PediatricsOrebro University HospitalOrebroSweden
- Division of Epidemiology and Public Health, School of MedicineUniversity of NottinghamNottinghamUK
- Department of MedicineColumbia University College of Physicians and SurgeonsNew York CityNew YorkUSA
| | - Henrik Toft Sørensen
- Department of Clinical EpidemiologyAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Ola Olén
- Department of Clinical Science and Education SödersjukhusetKarolinska InstitutetStockholmSweden
- Clinical Epidemiology Division, Department of MedicineSolna Karolinska InstitutetStockholmSweden
- Sachs' Children and Youth HospitalStockholm South General HospitalStockholmSweden
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26
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Barnes EL, Hanson JS, Regueiro MD, Saha S, Sands BE, Rubin DT, Dubinsky MC, Siegel CA, Gazis DR, Crawford JM, Long MD. Older Adult Patients Use More Aminosalicylate Monotherapy Compared With Younger Patients With Inflammatory Bowel Disease: TARGET-IBD. J Clin Gastroenterol 2022; 56:529-535. [PMID: 34115661 DOI: 10.1097/mcg.0000000000001557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/13/2021] [Indexed: 12/10/2022]
Abstract
GOAL The goal of this study was to describe medication utilization patterns in older inflammatory bowel disease (IBD) patients. BACKGROUND Despite a growing population of older patients with Crohn's disease (CD) and ulcerative colitis (UC), questions remain regarding medication utilization patterns in comparison to younger populations. MATERIALS AND METHODS We collected data from the 34 sites in TARGET-IBD, a multicenter, observational cohort. The primary outcome in this study was the IBD-specific therapy utilized among older patients with IBD compared with younger age groups. Therapy use was analyzed using pairwise comparisons and then the odds of IBD-specific therapy use among patients older than age 65 were evaluated using multivariable logistic regression models. RESULTS We identified 2980 patients with IBD (61% CD). In multivariable analysis, younger patients with UC were significantly less likely to utilize aminosalicylate monotherapy when compared with patients above 65 years [age 18 to 29: adjusted odds ratio (aOR)=0.51, 95% confidence interval (CI): 0.33-0.78]. In patients with CD, younger patients were significantly less likely to use aminosalicylate monotherapy when compared with patients above 65 (greatest difference age 18 to 29: aOR=0.31, 95% CI: 0.18-0.52). Younger patients with CD and UC were significantly more likely to use anti-tumor necrosis factor monotherapy than patients above 65 years (age 18 to 29: aOR=3.87, 95% CI: 2.47-6.06 and aOR=2.68, 95% CI: 1.29-5.58, respectively). CONCLUSIONS Older patients with IBD demonstrate significant differences in medication utilization, including more aminosalicylate monotherapy and less anti-tumor necrosis factor monotherapy compared with younger age groups. Given the aging population in the United States, these utilization patterns may have long-term implications for disease control.
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Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill
| | - John S Hanson
- Atrium Health Gastroenterology and Hepatology, Charlotte
| | - Miguel D Regueiro
- Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Bruce E Sands
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai
| | - David T Rubin
- IBD Center, The University of Chicago Medicine, Chicago, IL
| | - Marla C Dubinsky
- Division of Pediatric Gastroenterology, The Susan & Leonard Feinstein IBD Clinical Center at Icahn School of Medicine at Mount Sinai, New York, NY
| | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill
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Pabla BS, Alex Wiles C, Slaughter JC, Scoville EA, Dalal RL, Beaulieu DB, Schwartz DA, Horst SN. Safety and Efficacy of Vedolizumab Versus Tumor Necrosis Factor α Antagonists in an Elderly IBD Population: A Single Institution Retrospective Experience. Dig Dis Sci 2022; 67:3129-3137. [PMID: 34268660 DOI: 10.1007/s10620-021-07129-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/21/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vedolizumab is a monoclonal antibody used to treat inflammatory bowel disease (IBD). There is little known about the safety and comparative efficacy of this agent in the elderly population. AIMS Here, we present data on the safety and comparative efficacy of vedolizumab versus tumor necrosis factor α antagonists (anti-TNF) in elderly patients with IBD. METHODS This retrospective cohort study included IBD patients started on vedolizumab or anti-TNF at age 60 or older at a single tertiary IBD center. Safety was evaluated by assessing for the development of serious infection. The comparative needs for IBD-related surgery, IBD-related hospitalization, and drug discontinuation for any reason were obtained. Efficacy was assessed by comparing changes in endoscopic, histologic, and patient-report outcomes. RESULTS 212 cases were identified-108 patients treated with vedolizumab and 104 patients treated with anti-TNF. There were no significant differences between cohorts in serious infection, surgical intervention, or IBD-hospitalization-free survival (p = NS). Drug discontinuation survival was different between anti-TNF and vedolizumab (p = 0.02) with more patients remaining on vedolizumab at the time of last follow-up (51.9% vs. 25.9%). Endoscopic remission and response rates were higher in the vedolizumab versus anti-TNF group (65.7% vs. 45.2%, p = 0.02; 80.0% vs. 59.3%, p < 0.001). CONCLUSIONS In a cohort of IBD patients over age 60, vedolizumab showed no statistically significant differences in infection, hospitalization, or surgical intervention-free survival as compared to anti-TNF. Vedolizumab was discontinued less frequently than anti-TNF. Patients on vedolizumab had higher rates of endoscopic remission and response.
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Affiliation(s)
- Baldeep S Pabla
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA.
| | - C Alex Wiles
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, USA
| | | | - Elizabeth A Scoville
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA
| | - Robin L Dalal
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA
| | - Dawn B Beaulieu
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA
| | - David A Schwartz
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA
| | - Sara N Horst
- Division of Internal Medicine, Department of Gastroenterology, Vanderbilt Inflammatory Bowel Diseases Center, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20500, Nashville, TN, 37204, USA
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Pugliese D, Privitera G, Crispino F, Mezzina N, Castiglione F, Fiorino G, Laterza L, Viola A, Bertani L, Caprioli F, Cappello M, Barberio B, Ricci C, Balestrieri P, Daperno M, Pluchino D, Rizzello F, Scribano ML, Sablich R, Pastorelli L, Manguso F, Variola A, Di Sario A, Grossi L, Armuzzi A, Biscaglia G, Buda A, Mocci G, Viscido A, Di Paolo MC, Onali S, Rodino S, Coletta M, Principi M, Miranda A, Amato A, Bezzio C, Petruzzellis C, Mazzuoli S, Festa S, Sartini A, Checchin D, Fanigliulo L, Gallina S, Cesarini M, Bodini G, Stradella D, Spagnuolo R, Guidi L, Savarino E, Scrivo B, Soru P, Costa F, Fries W, Scaldaferri F, Allocca M, Pellegrini L, Massari A, Orlando A. Effectiveness and safety of vedolizumab in a matched cohort of elderly and nonelderly patients with inflammatory bowel disease: the IG-IBD LIVE study. Aliment Pharmacol Ther 2022; 56:95-109. [PMID: 35876062 PMCID: PMC9324100 DOI: 10.1111/apt.16923] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/13/2022] [Accepted: 03/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vedolizumab registration trials were the first to include elderly patients with moderate-to-severe ulcerative colitis (UC) or Crohn's disease (CD), but few real-life data have been reported in this population. AIMS We investigated the effectiveness and safety of vedolizumab in matched cohorts of elderly and nonelderly UC and CD patients. METHODS The Long-term Italian Vedolizumab Effectiveness (LIVE) study is a retrospective-prospective study including UC and CD patients who started vedolizumab from April 2016 to June 2017. Elderly patients (≥65 years) were matched clinically 1:2 to nonelderly patients (18-64 years); the 2 groups were followed until drug discontinuation or June 2019. RESULTS The study included 198 elderly (108 UC, 90 CD) and 396 matched nonelderly patients (205 UC, 191 CD). Nonelderly UC patients had a significantly higher persistence on vedolizumab compared to elderly patients (67.6% vs. 51.4%, p = 0.02). No significant difference in effectiveness was observed between elderly and nonelderly CD patients (59.4% vs. 52.4%, p = 0.32). Age ≥65 years was associated with lower persistence in UC; for CD, previous exposure to anti-TNF-α agents, Charlson comorbidity index >2 and moderate-to-severe clinical activity at baseline were associated with lower persistence. There were recorded 130 adverse events, with comparable rates between the two groups. A Charlson comorbidity index >2 was associated with an increased risk of adverse events. CONCLUSION Vedolizumab can be considered a safe option in elderly IBD patients. Its effectiveness in elderly UC patients may be reduced, while no age-dependent effect on effectiveness was observed in CD.
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Affiliation(s)
- Daniela Pugliese
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCSRomeItaly
| | - Giuseppe Privitera
- Dipartimento Universitario di Medicina e Chirurgia TraslazionaleUniversità Cattolica del Sacro CuoreRomeItaly
| | - Federica Crispino
- Riuniti Villa Sofia–Cervello Hospital, Internal Medicine e 2IBD Unit PalermoPalermoItaly
| | - Nicolò Mezzina
- Department of Biochemical and Clinical Science “L. Sacco” ASST Fatebenefratelli Sacco–University of MilanMilanItaly
| | | | - Gionata Fiorino
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy¸ Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Lucrezia Laterza
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCSRomeItaly
| | - Anna Viola
- UOSD Malattie Intestinali Croniche, Dip. di Medicina Clinica e SperimentalePoliclinico MessinaSicilyItaly
| | - Lorenzo Bertani
- Gastroenterology and Digestive Endoscopy Department of Medical Specialties Apuane HospitalTuscany North‐West ASLMassaItaly
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Department of Pathophysiology and TransplantationUniversity of MilanMilanLombardiaItaly
| | - Maria Cappello
- Head IBD Clinic, Gastroenterology Section, PromiseUniversity of PalermoSicilyItaly
| | - Brigida Barberio
- Gastroenterology Unit, Department of Surgery, Oncology and GastroenterologyUniversity of PaduaPaduaItaly
| | - Chiara Ricci
- Gastroenterology Unit, Spedali Civili Hospital, Department of Experimental and Clinical SciencesUniversity of BresciaBresciaItaly
| | - Paola Balestrieri
- Unit of Digestive Disease of Campus Bio Medico University of RomeItaly
| | - Marco Daperno
- Gastroenterology UnitAzienda Ospedaliera Ordine Mauriziano di TorinoTorinoPiemonteItaly
| | - Dario Pluchino
- Gastroenterology UnitA.O.U. Policlinico "Vittorio Emanuele"CataniaItaly
| | - Fernando Rizzello
- Department of Internal Medicine and GastroenterologyPoliclinico Sant’Orsola MalpighiBolognaItaly
| | | | - Renato Sablich
- Gastroenterology UnitSanta Maria degli Angeli HospitalPordenoneItaly
| | - Luca Pastorelli
- Gastroenterology UnitIRCCS Policlinico San Donato Research HospitalMilanItaly
| | - Francesco Manguso
- Gastoenterology UnitAO A. CardarelliVia A. Cardarelli, 5Naples80131Italy
| | - Angela Variola
- IBD Unit, IRCCS Sacro Cuore Don CalabriaNegrar di ValpolicellaVeronaItaly
| | - Antonio Di Sario
- Clinica di GastroenterologiaUniversità Politecnica delle MarcheAnconaItaly,IBD‐UNIT, and Dipartimento Gastroenterologico e dei TrapiantiPolo Ospedaliero‐Universitario "Umberto I‐G.M. Lancisi‐ G. Salesi"AnconaItaly
| | - Laurino Grossi
- G. D’Annunzio University‐Digestive Physiopathology Ospedale Spirito Santo PescaraPescaraItaly
| | - Alessandro Armuzzi
- IBD CenterIRCCS Humanitas Research HospitalMilanItaly,Department of Biomedical Sciences, Humanitas UniversityPieve EmanueleMilanItaly
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Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks? Drugs Aging 2022; 39:441-452. [PMID: 35641753 PMCID: PMC9155981 DOI: 10.1007/s40266-022-00943-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 02/07/2023]
Abstract
The number of patients with inflammatory bowel disease (IBD) approaching an older age, together with the number of over-60-year-old patients newly diagnosed with IBD, is steadily increasing, reaching 25% of all patients. The present review focuses on late-onset ulcerative colitis (UC) and its initial disease course in comparison with that observed in younger adults in terms of extension at onset and the risk of proximal disease progression, medical treatment, surgery and hospitalization in the first years after diagnosis. We summarize the clues pointing to a milder disease course in a population which frequently presents major frailty due to comorbidities. With increasing age and thus increasing comorbidities, medical and surgical therapies frequently represent a challenge for treating physicians. The response, persistence, and risks of adverse events of conventional therapies indicated for late onset/older UC patients are examined, emphasizing the risks in this particular population, who are still being treated with prolonged corticosteroid therapy. Finally, we concentrate on data on biotechnological agents for which older patients were mostly excluded from pivotal trials. Real-life data from newer agents such as vedolizumab and ustekinumab show encouraging efficacy and safety profiles in the population of older UC patients.
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Hong SJ, Galati J, Katz S. Crohn's Disease of the Elderly: Unique Biology and Therapeutic Efficacy and Safety. Gastroenterol Clin North Am 2022; 51:425-440. [PMID: 35595423 DOI: 10.1016/j.gtc.2021.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) is increasing in the elderly population. Compared with patients with onset during younger years, patients with elderly-onset IBD have a distinct clinical presentation, disease phenotype, and natural history. Genetics contribute less to pathogenesis of disease, whereas aging-related biological changes, such as immunosenescence and dysbiosis, are associated with elderly-onset IBD. Frailty is an increasingly recognized predictor of adverse outcomes. As an increasingly wider array of biologic and small molecule therapeutic options becomes available, data regarding efficacy and safety of these agents in patients are paramount given the unique characteristics of this population.
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Affiliation(s)
- Simon J Hong
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center at New York University Langone Health, 305 East 33rd St, New York, NY 10016, USA.
| | - Jonathan Galati
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center at New York University Langone Health, 305 East 33rd St, New York, NY 10016, USA
| | - Seymour Katz
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center at New York University Langone Health, 305 East 33rd St, New York, NY 10016, USA
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Okabayashi S, Yamazaki H, Tominaga K, Miura M, Sagami S, Matsuoka K, Yamaguchi Y, Noake T, Ozeki K, Miyazaki R, Kamano T, Fukuda T, Yoshioka K, Ando K, Fukuzawa M, Andoh A, Yamamoto Y, Hibi T, Kobayashi T. Lower effectiveness of intravenous steroid treatment for moderate-to-severe ulcerative colitis in hospitalised patients with older onset: a multicentre cohort study. Aliment Pharmacol Ther 2022; 55:1569-1580. [PMID: 35274323 DOI: 10.1111/apt.16865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/05/2021] [Accepted: 02/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The increasing incidence of older-onset ulcerative colitis (UC), which has a higher risk of surgery, is a global health issue. However, data regarding intravenous steroid treatment, one of the important treatment options to avoid surgery, for older-onset UC is lacking. AIMS To evaluate the association between onset age and effectiveness of intravenous steroids in UC. METHODS This retrospective multicentre (27 facilities) cohort study included moderate-to-severe hospitalised UC patients who underwent their first intravenous steroids between April 2014 and July 2019. The primary outcome was clinical remission at day 30, using two-item patient-reported outcome scoring. The key secondary outcomes were risks of surgery and adverse events (death, infection and venous thrombosis) within 90 days. A modified Poisson regression model was used for analysis. RESULTS Overall, 467 UC patients (384 younger-onset and 83 older-onset) were enrolled. Clinical remission at day 30 was observed in 252 (65.6%) among younger-onset patients and 43 (51.8%) among older-onset patients (adjusted risk difference, -21.7% [95% CI, -36.1% to -7.2%]; adjusted risk ratio [ARR], 0.74 [95% CI, 0.59 to 0.93]). The risks of surgery and adverse events were higher in older-onset UC (20.5% vs. 3.1%; ARR, 8.92 [95% CI, 4.13 to 19.27], 25.3% vs. 9.1%; ARR, 2.19 [95% CI, 1.22 to 3.92], respectively). Four deaths occurred, all involving older-onset UC. The risks of infection and venous thrombosis were also higher in older-onset UC (18.1% vs. 8.6%, 7.2% vs. 0.5%, respectively). CONCLUSIONS Older-onset was associated with a lower effectiveness of intravenous steroids with higher risks of surgery and adverse events in UC.
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Affiliation(s)
- Shinji Okabayashi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Miki Miura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shintaro Sagami
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Yoshiharu Yamaguchi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Toshihiro Noake
- Department of Surgery, Kurume Coloproctology Center, Fukuoka, Japan
| | - Keiji Ozeki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Ryosuke Miyazaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Kamano
- Department of gastroenterology, Fujita Health University, Aichi, Japan
| | - Tomohiro Fukuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kyoko Yoshioka
- Department of Gastroenterology, Kure Kyosai Hospital, Hiroshima, Japan
| | - Katsuyoshi Ando
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Asahikawa Medical University, Hokkaido, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Akira Andoh
- Division of Gastroenterology, Shiga University of Medical Science, Shiga, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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Okabayashi S, Yamazaki H, Matsuoka K, Yamamoto Y, Kobayashi T. Editorial: is older-onset ulcerative colitis more severe or less aggressively managed? Authors' reply. Aliment Pharmacol Ther 2022; 55:1352-1353. [PMID: 35472177 DOI: 10.1111/apt.16925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Shinji Okabayashi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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Fernandes RG, Radford-Smith G. Editorial: is older-onset ulcerative colitis more severe or less aggressively managed? Aliment Pharmacol Ther 2022; 55:1350-1351. [PMID: 35472185 DOI: 10.1111/apt.16905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Richard G Fernandes
- Department of Gastroenterology and Hepatology, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Graham Radford-Smith
- Department of Gastroenterology and Hepatology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Vieujean S, Caron B, Jairath V, Benetos A, Danese S, Louis E, Peyrin-Biroulet L. Is it time to include older adults in inflammatory bowel disease trials? A call for action. THE LANCET. HEALTHY LONGEVITY 2022; 3:e356-e366. [PMID: 36098310 DOI: 10.1016/s2666-7568(22)00060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023] Open
Abstract
The therapeutic management of older patients with inflammatory bowel disease (IBD) is challenging, particularly because of the absence of evidence-based guidelines for these patients, who seem to frequently be excluded from clinical trials. In this systematic review we investigated the exclusion of older patients with IBD from phase 3 studies registered on PubMed and ClinicalTrials.gov, by assessing the upper limit of age exclusion criteria and the percentage of patients older than 65 years included in the trials. Exclusion criteria other than age were also recorded, and comorbidities were analysed separately. Our review of 222 phase 3 studies shows that older patients are frequently excluded from IBD clinical trials because of their age, which was used as an exclusion criterion in 129 (58%) of the 222 assessed trials. Of the 32 trials that detailed the percentage of included patients who were 65 years or older, only 763 (5·4%) patients of the 14 124 patients included were older than 65 years. In addition to age, patients were also excluded because of comorbidities (mainly renal, hepatic, and cardiovascular, and used as an exclusion criterion in 76% of trials), a history of dysplasia (45% of trials), and previous treatment for IBD (19% of trials). We propose a three-step process that should enable the inclusion of all older patients in IBD clinical trials, regardless of their age, comorbidities, and frailty.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Vipul Jairath
- Department of Medicine, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Alimentiv, London, ON, Canada
| | - Athanase Benetos
- Inserm, DCAC, University of Lorraine, Vandoeuvre-lès-Nancy, France; CHRU-Nancy Brabois, Department of Clinical Geriatrics, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France.
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Elderly onset age is associated with low efficacy of first anti-tumor necrosis factor treatment in patients with inflammatory bowel disease. Sci Rep 2022; 12:5324. [PMID: 35351986 PMCID: PMC8964802 DOI: 10.1038/s41598-022-09455-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/22/2022] [Indexed: 12/13/2022] Open
Abstract
The outcomes of patients with elderly onset (EO) inflammatory bowel disease (IBD) treated with anti-tumor necrosis factor (TNF) remains uncertain. The present study evaluated the efficacy and safety of anti-TNF treatment for bio-naïve EO-IBD. Elderly patients were defined as those 60 years and older, and further divided into those with EO (Elderly-EO) and those with non-elderly onset (Elderly-NEO). A total of 432 bio-naïve patients were enrolled in this multicenter observational study, comprising 55 with Elderly-EO (12.7%), 25 with Elderly-NEO (5.8%), and 352 under age 60 (Non-elderly, 81.5%). After 52 weeks of anti-TNF treatment, clinical and steroid-free remission rates were significantly lower in Elderly-EO than in Non-elderly (37.7% and 60.8%; P = 0.001, and 35.9% and 57.8%; P = 0.003, respectively), and comparable between Elderly-NEO and Non-elderly. Multivariate analysis revealed that elderly onset was a significant factor for both clinical remission (OR, 0.49, 95% CI 0.25–0.96) and steroid-free remission (OR, 0.51, 95% CI 0.26–0.99) after 52 weeks of anti-TNF treatment. The rate of cumulative severe adverse events was significantly higher in Elderly-EO than in Non-elderly (P = 0.007), and comparable between Elderly-NEO and Non-elderly. In conclusion, anti-TNF treatment for bio-naïve EO-IBD may be less effective and raise safety concerns.
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Hyun HK, Zhang HS, Yu J, Kang EA, Park J, Park SJ, Park JJ, Kim TI, Kim WH, Cheon JH. Comparative effectiveness of second-line biological therapies for ulcerative colitis and Crohn’s disease in patients with prior failure of anti-tumour necrosis factor treatment. BMC Gastroenterol 2022; 22:143. [PMID: 35346063 PMCID: PMC8958783 DOI: 10.1186/s12876-022-02225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Therapeutic options for inflammatory bowel disease (IBD) have increased since the introduction of tumour necrosis factor (TNF) inhibitors a few decades ago. However, direct comparisons of the effectiveness of second-line biological agents in patients with ulcerative colitis (UC) and Crohn’s disease (CD) are lacking.
Methods
Patients with UC or CD who experienced anti-TNF treatment failure and subsequently used vedolizumab, ustekinumab, or tofacitinib as a second-line drug were retrospectively recruited. The primary outcomes were the clinical remission rate at week 16 and the cumulative relapse rate 48 weeks after receiving induction therapy.
Results
A total of 94 patients with UC or CD experienced anti-TNF treatment failure and received vedolizumab (UC: 37; CD: 28), ustekinumab (CD: 16), or tofacitinib (UC: 13). The clinical remission rates were not significantly different between the vedolizumab and tofacitinib groups in UC patients (56.8% vs. 46.2%, p = 0.509). In CD patients, the clinical remission rates were not significantly different between the vedolizumab and ustekinumab groups (53.6% vs. 50.0%, p = 0.820). Moreover, the cumulative rates of clinical relapse were not significantly different between the vedolizumab and tofacitinib groups in UC patients and between the vedolizumab and ustekinumab groups in CD patients (p = 0.396 and p = 0.692, respectively). Safety profiles were also similar among the treatment groups in both UC and CD patients.
Conclusions
After prior anti-TNF therapy failure, vedolizumab and tofacitinib in UC patients and vedolizumab and ustekinumab in CD patients were not significantly different in terms of the efficacy in inducing and maintaining a clinical response.
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Wang JH, D’Arcy M, Barnes EL, Freedman ND, Engels EA, Song M. Associations of Inflammatory Bowel Disease and Subsequent Cancers in a Population-Based Study of Older Adults in the United States. JNCI Cancer Spectr 2022; 6:pkab096. [PMID: 35071980 PMCID: PMC8767622 DOI: 10.1093/jncics/pkab096] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/08/2021] [Accepted: 10/27/2021] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Cancer risk is elevated in patients with inflammatory bowel disease (IBD). A comprehensive investigation of cancer risk in older patients (≥66 years of age) is needed, because this understudied population is at high risk. METHODS We performed a case-control study using Surveillance Epidemiology and End Results-Medicare data including 1 986 735 incident cancer cases (aged 66-99 years; diagnosed 1992-2015) and 200 000 controls matched by sex, age, race and ethnicity, and selection year. IBD was identified by ulcerative colitis (UC) or Crohn's disease (CD) diagnosis codes. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated with logistic regression, adjusting for potential confounders. For colorectal cancers, we further adjusted for screening rates. We assessed confounding by medication exposure among patients with prescription drug coverage. RESULTS IBD, CD, and UC were present in 0.8%, 0.3%, and 0.5% in both cancer cases and non-cancer controls. Of 51 cancers examined, IBD was statistically significantly associated with cancers of the small intestine (OR = 2.55, 95% CI = 2.15 to 3.01), intrahepatic (OR = 1.92, 95% CI = 1.47 to 2.51) and extrahepatic bile ducts (OR = 1.75, 95% CI = 1.38 to 2.22), rectum (OR = 1.61, 95% CI = 1.36 to 1.90), and colon (OR = 1.21, 95% CI = 1.10 to 1.33). CD was associated with cancers of the small intestine (OR = 4.55, 95% CI = 3.65 to 5.67), and UC was associated with cancers of the intrahepatic bile ducts (OR = 1.87, 95% CI = 1.34 to 2.61), rectum (OR = 1.80, 95% CI = 1.47 to 2.20), and colon (OR = 1.28, 95% CI = 1.14 to 1.43). After adjusting for medication exposure, IBD was not statistically significantly associated with lung cancer, melanoma, diffuse large B-cell lymphoma, and myelodysplastic syndrome. CONCLUSIONS In this large study among older adults (≥66 years of age), IBD was positively associated with gastrointestinal cancers. Associations with extraintestinal cancers may reflect the effect of immunosuppressive medications.
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Affiliation(s)
- Jeanny H Wang
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, MD, USA
| | - Monica D’Arcy
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, Rockville, MD, USA
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, National Cancer Institute, Rockville, MD, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, MD, USA
| | - Minkyo Song
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, MD, USA
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Inflammatory Bowel Disease Patients Who Respond to Treatment with Anti-tumor Necrosis Factor Agents Demonstrate Improvement in Pre-treatment Frailty. Dig Dis Sci 2022; 67:622-628. [PMID: 33932198 PMCID: PMC8558109 DOI: 10.1007/s10620-021-06990-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/02/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Frailty may be a risk factor for complications in inflammatory bowel diseases (IBD) patients. We examined the impact of treatment on IBD patients who were frail prior to treatment and identified predictors of post-treatment change in frailty. METHODS In an electronic health record-based cohort of IBD patients initiating anti-tumor necrosis factor (TNF)-α agents, we applied a validated claims-based frailty index to determine frailty in the 1 year prior to and after treatment initiation. We characterized treatment non-response using a composite outcome of IBD-related hospitalization, surgery, change in therapy, or initiation of systemic steroids. We constructed multivariable logistic regression models to identify determinants of post-treatment frailty. RESULTS The 1210 patients initiating anti-TNF therapy had a median age of 30 years; 20% were ≥ 50 years. In the first year after anti-TNF initiation, 40% were non-responders. Many more treatment non-responders were frail in the year following treatment compared with treatment responders (27% vs 7%, p < 0.001). Pre-treatment frailty (OR 2.01, 95% CI 1.35-3.00) and prior IBD-related hospitalization (OR 1.63, 95% CI 1.15-2.30) were independently predictive of higher likelihood of post-treatment frailty. Therapy response was associated with a lower likelihood (OR 0.24, 95% CI 0.16-0.34) of post-treatment frailty. Nearly 85% of patients who were frail prior to treatment demonstrated improvement in frailty following treatment CONCLUSIONS: Response to anti-TNF therapy is an important determinant of post-treatment frailty in patients with IBD. Our findings suggest that effectively treating inflammatory states in older patients with IBD may improve frailty.
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Nishida Y, Hosomi S, Fujimoto K, Nakata R, Sugita N, Itani S, Nadatani Y, Fukunaga S, Otani K, Tanaka F, Nagami Y, Taira K, Kamata N, Watanabe T, Ohfuji S, Fujiwara Y. Impact of the Lockdown Due to the COVID-19 Pandemic on Patients With Inflammatory Bowel Disease. Front Med (Lausanne) 2021; 8:649759. [PMID: 34957131 PMCID: PMC8702803 DOI: 10.3389/fmed.2021.649759] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 11/23/2021] [Indexed: 12/28/2022] Open
Abstract
Background: The government of Japan declared a state of emergency on April 16, 2020, owing to the coronavirus disease 2019 (COVID-19) pandemic. The subsequent lockdown altered lifestyles and worsened mental illnesses. Inflammatory bowel disease (IBD) is an intestinal disorder that is affected by environmental factors. Therefore, we aimed to assess the effects of COVID-19 and the state of emergency on the lifestyle and disease activity of patients with IBD. Methods: We conducted a questionnaire survey on patients with IBD from June 16 to August 21, 2020 during their regular follow-up at our hospital, 2 months after the state of emergency was declared. Results: Overall, 241 patients with ulcerative colitis (UC) and 210 with Crohn's disease (CD) completed the survey, of which 82 (34%) and 97 (46%) patients, respectively, reported disease exacerbation within 2 months after the lockdown. Multivariate logistic regression analysis identified age at enrollment (odds ratio, OR 0.98, 95% CI 0.96-0.99; P < 0.05), sleep hours (OR, 0.74; 95% CI, 0.57-0.97; P < 0.05), and increased stress due to the COVID-19 pandemic (OR, 6.06; 95% CI, 1.79-20.50; P < 0.01) as independent factors associated with UC exacerbation. Patients with exacerbated CD were younger at CD onset and had higher patient-reported outcome 2 scores before the state of emergency than patients with non-exacerbated CD. On multivariate analysis, age (OR, 0.97; 95% CI, 0.95-0.99; P < 0.01) and active disease before the state of emergency (OR, 2.20; 95% CI, 1.23-3.95; P < 0.01) were independently associated with CD exacerbation. Conclusions: Improving sleep quality and preventing psychological stress may be crucial in IBD management during a pandemic, especially in young patients.
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Affiliation(s)
- Yu Nishida
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Fujimoto
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Rieko Nakata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Naoko Sugita
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shigehiro Itani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuji Nadatani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shusei Fukunaga
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Fousekis FS, Katsanos AH, Kourtis G, Saridi M, Albani E, Katsanos KH, Christodoulou DK. Inflammatory Bowel Disease and Patients With Mental Disorders: What Do We Know? J Clin Med Res 2021; 13:466-473. [PMID: 34691320 PMCID: PMC8510650 DOI: 10.14740/jocmr4593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a multisystemic disease with a wide range of extraintestinal manifestations in both ulcerative colitis and Crohn’s disease, while increasing evidence supports the interaction between gut and central nervous system, described as “gut-brain axis”. According to epidemiological studies, it seems that patients with IBD present more frequently with impaired mental status compared to the general population, leading to diagnostic and management problems in this group of patients. The association between IBD and mental disorders, such as dementia and autism spectrum disorders, has not been fully clarified; genetic factors and the gut-brain axis seem to be involved. The purpose of this review is to present and analyze the epidemiological data about this issue, describe the possible pathogenetic mechanisms and discuss some considerations about the management of patients with IBD and impaired mental status.
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Affiliation(s)
- Fotios S Fousekis
- Department of Gastroenterology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | | | | | | | | | - Konstantinos H Katsanos
- Department of Gastroenterology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Department of Gastroenterology, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Machine Learning Modeling from Omics Data as Prospective Tool for Improvement of Inflammatory Bowel Disease Diagnosis and Clinical Classifications. Genes (Basel) 2021; 12:genes12091438. [PMID: 34573420 PMCID: PMC8466305 DOI: 10.3390/genes12091438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/21/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
Research of inflammatory bowel disease (IBD) has identified numerous molecular players involved in the disease development. Even so, the understanding of IBD is incomplete, while disease treatment is still far from the precision medicine. Reliable diagnostic and prognostic biomarkers in IBD are limited which may reduce efficient therapeutic outcomes. High-throughput technologies and artificial intelligence emerged as powerful tools in search of unrevealed molecular patterns that could give important insights into IBD pathogenesis and help to address unmet clinical needs. Machine learning, a subtype of artificial intelligence, uses complex mathematical algorithms to learn from existing data in order to predict future outcomes. The scientific community has been increasingly employing machine learning for the prediction of IBD outcomes from comprehensive patient data-clinical records, genomic, transcriptomic, proteomic, metagenomic, and other IBD relevant omics data. This review aims to present fundamental principles behind machine learning modeling and its current application in IBD research with the focus on studies that explored genomic and transcriptomic data. We described different strategies used for dealing with omics data and outlined the best-performing methods. Before being translated into clinical settings, the developed machine learning models should be tested in independent prospective studies as well as randomized controlled trials.
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Shimodaira Y, Watanabe K, Iijima K. Clinical Course of Ulcerative Colitis Associated with an Age at Diagnosis: A Recent Japanese Database Survey. TOHOKU J EXP MED 2021; 255:33-39. [PMID: 34511579 DOI: 10.1620/tjem.255.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The onset age of ulcerative colitis has been increasing in several countries. Furthermore, the number of elderly patients with ulcerative colitis has been increasing in an aging society. We investigated the incidence of ulcerative colitis patients in Japan using a large-scale health insurance claims database to survey the ulcerative colitis incidence ratio and the clinical characteristics in late-onset ulcerative colitis patients. Newly diagnosed 2,791 ulcerative colitis between 2015 and 2018 was investigated. Medical treatment within 12 months of diagnosis was analyzed among 0-19, 20-39, 40-59 and 60-75 age groups. The mean age at diagnosis was 40.3 years (SD: 12.9), and the incidence ratio peaked in the 40's. Most of patients received 5-aminocylitic acid (91.7%), a subset of patients received prednisolone (20.1%), and a small number of patients took immunomodulator (6.8%), cytapheresis (3.3%), anti-TNFα therapy (4.3%), and colectomy (1.0%) within 12 months after diagnosis. All treatments except colectomy were most frequent in the 0-19 age group; however, colectomy was most frequent in 60-75 age group. The clinical course of ulcerative colitis that developed in adults did not differ significantly in terms of medical treatment within 12 months from the onset; meanwhile, the surgery rate was high in elderly patients. It is necessary to pay close attention to future trends regarding the aging of the onset age and the treatment, especially for late-onset ulcerative colitis patients.
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Affiliation(s)
- Yosuke Shimodaira
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine
| | - Kenta Watanabe
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine
| | - Katsunori Iijima
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine
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Katz S, Kane SV. Myths and Misconceptions in the Management of Elderly Patients With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2021; 17:415-419. [PMID: 34602906 PMCID: PMC8475257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Seymour Katz
- Department of Medicine Director, NYU IBD Outreach Program New York University Grossman School of Medicine New York, New York
- Mayo Clinic Rochester, Minnesota
| | - Sunanda V Kane
- Department of Medicine Director, NYU IBD Outreach Program New York University Grossman School of Medicine New York, New York
- Mayo Clinic Rochester, Minnesota
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Zhu M, Ran Z. Clinical characteristics of ulcerative colitis in elderly patients. JGH Open 2021; 5:849-854. [PMID: 34386591 PMCID: PMC8341179 DOI: 10.1002/jgh3.12612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 12/18/2022]
Abstract
The incidence of ulcerative colitis (UC) in elderly patients is increasing. Elderly UC patients are likely to exhibit distinct features both at diagnosis and during follow-up. Age-related problems, including complications, immune dysfunction, and multidrug use, make the diagnosis and treatment of elderly UC more challenging. Suboptimal treatment considering adverse events leads to poor clinical outcome in elderly UC patients. Here, we reviewed the epidemiology, clinical presentation, medical therapy, colorectal cancer surveillance of UC in elderly patients.
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Affiliation(s)
- Mingming Zhu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Inflammatory Bowel Disease Research Center, Renji Hospital, School of MedicineShanghai Jiao Tong University, Shanghai Jiao Tong University; Shanghai Institute of Digestive DiseaseShanghaiChina
| | - Zhihua Ran
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Inflammatory Bowel Disease Research Center, Renji Hospital, School of MedicineShanghai Jiao Tong University, Shanghai Jiao Tong University; Shanghai Institute of Digestive DiseaseShanghaiChina
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45
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Hong SJ, Katz S. The elderly IBD patient in the modern era: changing paradigms in risk stratification and therapeutic management. Therap Adv Gastroenterol 2021; 14:17562848211023399. [PMID: 34276809 PMCID: PMC8255562 DOI: 10.1177/17562848211023399] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/20/2021] [Indexed: 02/04/2023] Open
Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) is rising in the elderly population. Compared with patients with onset during their younger years, patients with elderly onset IBD have a distinct clinical presentation, disease phenotype, and natural history. Genetics contribute less to pathogenesis of disease, whereas biological changes associated with aging including immunosenescence, dysbiosis, and frailty have a greater impact on disease outcomes. With the advent of an increasingly wider array of biologic and small-molecule therapeutic options, data regarding efficacy and safety of these agents in elderly IBD patients specifically are paramount, given the unique characteristics of this population.
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Affiliation(s)
- Simon J. Hong
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, 305 East 33rd Street, New York, NY 10016-4576, USA
| | - Seymour Katz
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
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46
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Agrawal M, Spencer EA, Colombel JF, Ungaro RC. Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User's Guide for Adult and Pediatric Gastroenterologists. Gastroenterology 2021; 161:47-65. [PMID: 33940007 PMCID: PMC8640961 DOI: 10.1053/j.gastro.2021.04.063] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 04/27/2021] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis, are chronic, progressive, immune-mediated diseases of adults and children that have no cure. IBD can cause significant morbidity and lead to complications such as strictures, fistulas, infections, and cancer. In children, IBD can also result in growth impairment and pubertal delays. IBD is highly heterogenous, with severity ranging from mild to severe and symptoms ranging from mild to debilitating. Delay in IBD diagnosis, especially in Crohn's disease, is common and associated with adverse outcomes. Early diagnosis and prompt institution of treatment are the cornerstones for improving outcomes and maximizing health. Early diagnosis requires a low threshold of suspicion and red flags to guide early specialist referral at the primary provider level. Although the armamentarium of IBD medications is growing, many patients will not respond to treatment, and the selection of first-line therapy is critical. Risk stratification of disease severity, based on clinical, demographic, and serologic markers, can help guide selection of first-line therapy. Clinical decision support tools, genomics, and other biomarkers of response to therapy and risk of adverse events are the future of personalized medicine. After starting appropriate therapy, it is important to confirm remission using objective end points (treat to target) with continued control of inflammation with adjustment of therapy using surrogate biomarkers (tight control). Lastly, IBD therapy extends far beyond medications, and other aspects of the overall health and wellbeing of the patient are critical. These include preventive health, nutrition, and psychobehavioral support addressing patients' concerns around complementary therapy and medication adherence, prevention of disability, and ensuring open communication.
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Affiliation(s)
- Manasi Agrawal
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Elizabeth A. Spencer
- The Division of Pediatric Gastroenterology and Nutrition, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan C. Ungaro
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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Na SY. [Treatment of Inflammatory Bowel Disease in Elderly Patients - What Are Different and What Should We Know?]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 77:231-240. [PMID: 34035201 DOI: 10.4166/kjg.2021.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022]
Abstract
As the incidence of inflammatory bowel disease (IBD) are increasing with an ageing population, the incidence and prevalence of IBD in the elderly continue to increase. Older IBD patients can be classified into two groups; elderly-onset IBD patients and elderly IBD patients who were diagnosed at a young age and transitioning into advanced age. Clinicians must consider elderly-onset specific phenotypes or prognosis and age-related concerns in the treatment of elderly IBD patients. There is a paucity of evidence whether there is a different disease process when IBD occurs in older age yet. Clinicians may expect similar therapeutic effects in older and younger patients in drug selection, but since older patients are often excluded from clinical trials, evidence to support this assumption is currently lacking. Also, the risk of side effects may be higher in elderly patients. Therefore, when making management decisions in the elderly, clinicians should assess an individual's frailty rather than only considering an individual's chronological and biological age. Knowing specific requirements for managing older IBD patients may help to make an appropriate therapeutic strategy for this patient group.
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Affiliation(s)
- Soo-Young Na
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Gubatan J, Levitte S, Patel A, Balabanis T, Wei MT, Sinha SR. Artificial intelligence applications in inflammatory bowel disease: Emerging technologies and future directions. World J Gastroenterol 2021; 27:1920-1935. [PMID: 34007130 PMCID: PMC8108036 DOI: 10.3748/wjg.v27.i17.1920] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/04/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a complex and multifaceted disorder of the gastrointestinal tract that is increasing in incidence worldwide and associated with significant morbidity. The rapid accumulation of large datasets from electronic health records, high-definition multi-omics (including genomics, proteomics, transcriptomics, and metagenomics), and imaging modalities (endoscopy and endomicroscopy) have provided powerful tools to unravel novel mechanistic insights and help address unmet clinical needs in IBD. Although the application of artificial intelligence (AI) methods has facilitated the analysis, integration, and interpretation of large datasets in IBD, significant heterogeneity in AI methods, datasets, and clinical outcomes and the need for unbiased prospective validations studies are current barriers to incorporation of AI into clinical practice. The purpose of this review is to summarize the most recent advances in the application of AI and machine learning technologies in the diagnosis and risk prediction, assessment of disease severity, and prediction of clinical outcomes in patients with IBD.
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Affiliation(s)
- John Gubatan
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Steven Levitte
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Akshar Patel
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Tatiana Balabanis
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Mike T Wei
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Sidhartha R Sinha
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
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Cheng D, Cushing KC, Cai T, Ananthakrishnan AN. Safety and Efficacy of Tumor Necrosis Factor Antagonists in Older Patients With Ulcerative Colitis: Patient-Level Pooled Analysis of Data From Randomized Trials. Clin Gastroenterol Hepatol 2021; 19:939-946.e4. [PMID: 32371165 DOI: 10.1016/j.cgh.2020.04.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Treatment of older patients (more than 60 years) with ulcerative colitis (UC) can be a challenge, because they might be more vulnerable to adverse events (AEs). We determined the effects of age on the safety and efficacy of anti-tumor necrosis factor (TNF) therapy in a pooled analysis of data from randomized trials. METHODS We obtained individual patient-level data from 4 trials of anti-TNF therapy for patients with UC from the Yale Open Data Access Project. Participants were assigned to groups of older age (60 years or older) and younger age (younger than 60 years). The primary outcome was difference in serious AEs (SAEs), defined as death, life-threatening event, hospitalization, and/or significant disability. Secondary outcomes were severe infections, non-severe infections, neoplasms, and achievement of clinical remission, defined by trial investigators as Mayo score ≤ 2 with no sub-score >1 at the end of induction or maintenance therapy. A random effects logistic regression model was fitted to estimate the effect of anti-TNF therapy on safety and efficacy by age, adjusting for confounders and trial-level effects. RESULTS The study cohort included 2257 patients (231 60 years or older). Higher proportions of older patients receiving anti-TNF therapy had SAEs (20%) and hospitalizations (14.4%), compared with younger patients (10.2% had SAEs and 5.2% were hospitalized); there were no significant differences between groups in proportions with severe or non-severe infections. Compared with placebo, there was no significant difference in safety risks associated with anti-TNF therapy (SAEs reduced by 5.4% in older patients vs reduction of 2.4% in younger patients; hospitalizations reduced by 6.7% in older patients vs reduction of 2.5% in younger patients; severe infections reduced by 3.1% vs increase of 0.7% in younger patients). There was no significant difference in between older vs younger patients in efficacy of anti-TNF therapy in inducing remission (odds risk ratio, 1.05, 95% CI, 0.33-3.39) or in maintaining remission (odds risk ratio, 0.49; 95% CI, 0.18-1.33). CONCLUSIONS In a pooled analysis of data from randomized trials, we found that older patients with UC have an increased baseline increased risk of SAEs, but no increase in risk can be attributed to anti-TNF therapy in older vs younger patients.
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Affiliation(s)
- David Cheng
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Massachusetts General Hospital, Division of Gastroenterology, Boston, Massachusetts
| | - Kelly C Cushing
- Massachusetts General Hospital, Division of Gastroenterology, Boston, Massachusetts; Harvard University, Boston, Massachusetts; University of Michigan, Division of Gastroenterology, Ann Arbor, Michigan
| | - Tianxi Cai
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Massachusetts General Hospital, Division of Gastroenterology, Boston, Massachusetts
| | - Ashwin N Ananthakrishnan
- Massachusetts General Hospital, Division of Gastroenterology, Boston, Massachusetts; Harvard University, Boston, Massachusetts.
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Mak JWY, Lok Tung Ho C, Wong K, Cheng TY, Yip TCF, Leung WK, Li M, Lo FH, Ng KM, Sze SF, Leung CM, Tsang SWC, Shan EHS, Chan KH, Lam BCY, Hui AJ, Chow WH, Ng SC. Epidemiology and Natural History of Elderly-onset Inflammatory Bowel Disease: Results From a Territory-wide Hong Kong IBD Registry. J Crohns Colitis 2021; 15:401-408. [PMID: 32914171 DOI: 10.1093/ecco-jcc/jjaa181] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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 with those of 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 with those of 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 in 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 <0.001] than adult-onset CD. 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 hospitalisations [OR: 1.14; 95% CI 1.09-1.20; p <0.001], infections-related hospitalisation [OR: 1.87; 95% CI 1.47-2.38; p <0.001], and IBD-related hospitalisation [OR: 1.09; 95% CI 1.04- 1.15; p = 0.001] compared with adult-onset IBD patients. CONCLUSIONS Elderly-onset IBD was associated with increased risk of infections and cancer development, and increased infection- and IBD-related hospitalisations. Specific therapeutic strategies to target this special population are needed.
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Affiliation(s)
- Joyce Wing Yan Mak
- Department of Medicine and Therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
| | | | - Kylie Wong
- Department of Medicine and Therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
| | - Tsz Yan Cheng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
| | - Terry Cheuk Fung Yip
- Department of Medicine and Therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
| | - Wai Keung Leung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Michael Li
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong
| | - Fu Hang Lo
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong
| | - Ka Man Ng
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Shun Fung Sze
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Chi Man Leung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | - Kam Hon Chan
- Department of Medicine, North District Hospital, Hong Kong
| | - Belsy C Y Lam
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong
| | - Aric Josun Hui
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Wai Hung Chow
- Department of Medicine, Yan Chai Hospital, Hong Kong
| | - Siew Chien Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
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