CHRONOLOGICAL AGE INFLUENCES TREATMENT DECISION IN INFLAMMATORY BOWEL DISEASE

Background: Despite older adults making up roughly one quarter of patients with inflammatory bowel disease (IBD) in the United States, they are an understudied population. Although long-term treatment goals are to achieve steroid-free endoscopic remission, previous reports have indicated high use of chronic steroids and deferral of advanced therapies. To explore this, we assessed differences in medication usage between older and younger adults with IBD by disease activity.
Methods: We analyzed surveys from the Crohn’s and Colitis Foundation’s IBD Qorus learning health system for patient visits between 6/1/22 and 10/31/22. Patients were stratified by age (>60 years vs. ≤ 60 years), whether mucosal healing was achieved, and patients’ symptoms (none-mild or moderate-severe) based on PRO-2 UC and PRO-3 CD scores. Univariable analyses were conducted using Chi-square analysis or Fisher’s exact test where appropriate.
Results: The sample included 3,470 patient visits across 35 sites. 31% of the patients were >60 years old, 46.9% were male and 58.6% had Crohn’s disease (Table 1). Most (51.2%) older adults were treated with advanced therapies, 72.4% were in clinical remission (vs. 62.6% in younger adults, p<0.01), and 51.3% had mucosal healing (vs. 46.7% of younger adults, p<0.01). 5.7% of older patients were actively being treated with systemic corticosteroids, as compared to 7.4% of younger patients (p<.05). Older patients were more likely than younger patients to be treated with mesalamine (18.9% vs. 12.6%, p<.001) and anti-integrins (15.2% vs. 12.5%, p=.02) but less likely to be treated with anti-IL-12/23 inhibitors (12.6% vs. 15.5%, p=.01) or combination therapy (17% vs. 22%, p<.001). Amongst all patients without mucosal healing, there was no difference in advanced therapy usage regardless of disease activity (Table 2). Among older adults not achieving mucosal healing, providers were less likely to optimize current therapy (13.3% vs. 17.3% younger adults, p=.008) or add a new therapy (10% vs. 13% younger adults, p=.02). Providers cited a change in therapy would “not lead to meaningful impact” in 21% of older patients that were not in mucosal healing as compared to noting this in only 12% of younger adults (p<.001).
Conclusion: In this multicenter study, older adults with IBD were more likely to be in clinical and endoscopic remission than younger adults and also had lower use of steroids and hospital utilization. Medication prescribing patterns differed between the cohorts. Among those not achieving mucosal healing, clinicians were less likely to change therapy for older patients, as they felt it was not likely to have a meaningful impact, even among those with symptoms. Further studies are needed to better understand these differences in approaches in order to prevent bias in treatment selection.