Older patients missing out on IBD treatments

Safety concerns are limiting effective treatment of IBD in older patients and highlighting the importance of general preventive care.

Associate Professor Sally Bell, gastroenterologist at St Vincent’s Hospital Melbourne, told the limbic that older patients with IBD were less likely to receive immunomodulating drugs and biologics than younger IBD patients.

“There appears to be a reluctance to treat with these drugs due to the risk of complications in older people. But biological age is not the same as chronological age and we really need to focus on identifying individual risk,” she said.

“Treatment decisions are largely the same as for younger patients but doctors need to know more about their older patients with IBD and do more for them.”

Associate Professor Bell said there had to be a higher level of attention to detail in terms of monitoring risk and a rigorous preventive health program that could be shared with the patient’s GP.

She said vaccination, skin and colorectal cancer screening and cardiac risk factor reduction were particularly important.

“We know thiopurines and anti-TNFs are associated with an increased risk of serious infections and some cancers. However we can also modify exposure by, for example, using thiopurines short term rather than long term to reduce lymphoma risk.”

“While all therapy is more risky in older patients, they are probably better off on a more effective drug than being left with inadequate control of their IBD.”

She added that doctors had to discuss risks and benefits of various treatments with their patients rather than not presenting some treatment options.

“Patients appreciate the thought process that goes into choosing one treatment over another and they will often choose quality of life over quantity of life,” she said.

Professor Bell said vedolizumab generated a lot of discussion at the recent AGW meeting given it was associated with less immunosuppression and less risk of infection.

However it was a slower acting drug and better suited to slightly milder disease, she said.

Professor Bell said much of the research on IBD in older patients had combined those who had grown old with the disease and those who were diagnosed with late onset IBD after 60-65 years.

“So we’ve yet to tease out the relative impact of long standing disease and IBD drug exposure versus the impact of ageing on patient outcomes.”

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