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Ageing profile of IBD patients highlights need for safer meds

An Australian study has found the prevalence of IBD is high in older patients, prompting caution around the use of immunosuppressive medications in a population already at higher risk of infection.

The population-based study conducted in Sydney found the crude prevalence of IBD was 414 per 100,000 and slightly higher for Crohn’s disease than ulcerative colitis.

The median age of patients was 47 years. However, the age specific prevalence of IBD increased with age from 380 per 100,000 in 0-64 year olds, 612 per 100,000 for people aged ≥65 years and 891 per 100 000 for people aged ≥85 years.

Senior investigator on the study Professor Rupert Leong told the limbic the interquartile age range of IBD in the cohort was 34-62 years old – meaning half of all IBD were within this age group and a quarter were older than 62 years old.

“Ulcerative colitis, in particular, has a trend of increasing prevalence with age probably due to the fact they are non-smokers and remain healthier than their non-IBD counterparts in the community.”

Professor Leong said the increasing prevalence was due to the combination of some patients being diagnosed later in life as well as people diagnosed young and ageing with the disease.

“It’s encouraging to see that our IBD patients are living long lives”, said Professor Rupert Leong, Head of IBD Services and Director of Endoscopy at Concord Hospital.

“They are not dying of IBD and its complications. We manage them so well that we are preventing other chronic diseases,” he said.

However the fact that IBD patients were not always the archetypical young person in their 20s to 30s had implications for management.

“We need to use newer treatments – safer treatment that won’t increase their risk of infection and cancer,” Professor Leong said.

The study, published in the MJA, said systemic immunosuppressive therapy should be de-escalated and biologics which were less likely to lead to sepsis should be considered.

“Our findings highlight the importance of safer therapies, appropriate cancer screening, and taking comorbid conditions into account when managing older people with IBD,” it said.

Disclosures: Some of the study investigators including Professor Leong have declared competing interests such as receiving consultancy work, honoraria or research support from companies including Janssen which markets the biologic ustekinumab.