CHRONOLOGICAL AGE INFLUENCES TREATMENT DECISION IN INFLAMMATORY BOWEL DISEASE: AN IBD QORUS COLLABORATIVE STUDY
Authors: Kogan Lawrence , Faye Adam , Harvey Sarah , Oberai Ridhima , Siegel Corey , Melmed Gil , Singh Siddharth , Hudesman David , Gaidos Jill 
Published: January 2024

Abstract

BACKGROUND
Despite making up roughly one quarter of the patients with inflammatory bowel diseases (IBD) in the United States, older adults are an understudied population. Chronic steroid use may be as high as 40% in this population and advanced therapies are often deferred, even though long-term treatment goals are to achieve endoscopic remission utilizing steroid-sparing agents. In order to further explore this, we assessed differences in medication usage between older and younger adults with IBD, stratified 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 (&gt;60 years vs. ≤ 60 years), whether mucosal healing was achieved, and patients’ symptoms (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
Overall there were 3,470 patient visits across 35 sites. 31% of the patients were &gt;60 years old, 46.9% were male and 58.6% had Crohn’s disease (Table 1). In our cohort, 51.2% of older adults were treated with advanced therapies, 72.4% were in clinical remission (vs. 62.6% in younger adults, p&lt;0.01), and 51.3% achieved mucosal healing (vs. 46.7% of younger adults, p&lt;0.01). Only 5.7% of older patients had been treated with systemic steroids in the preceding 3 months. Older patients were more likely to be treated with mesalamine (18.9% vs. 12.6%, p&lt;.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). Amongst all patients with active disease, there was no difference in advanced therapy usage regardless of the whether the disease activity was mild or moderate-severe (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), citing that in 21% of cases they believed a change in therapy would “not lead to meaningful impact” as compared to noting this in only 12% of younger adults (p&lt;.001).

CONCLUSION
In this real-world, multicenter study, older adults with IBD were more likely to report clinical remission, and were also more likely to achieve endoscopic healing than younger adults. The biggest difference in medication use between the two groups was noted in those with mucosal healing. However, 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 in those with symptoms. Further studies will be needed to better understand these differences in approaches in order to prevent bias in treatment selection.

Table 1 Demographics of all patients in the study. Statistically significant differences are noted in bold.
* indicates that there were not enough patients to perform statistical analysis.

Table 2 Current medication use based on disease activity and patient symptoms. Statistically significant results are noted in bold.
* indicates that there were not enough patients to perform statistical analysis.