Skip to main content
SpringerLink
Log in

Management of Inflammatory Bowel Disease in the Elderly: Do Biologicals Offer A Better Alternative?

  • Current Opinion
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

The management of inflammatory bowel disease (IBD) in elderly patients provides added complexity for healthcare providers who need to take into account the high likelihood of co-morbid disease, the need for polypharmacy and, in many instances, greater patient fragility. While biologics are often considered first-line corticosteroid-sparing strategies for moderate to severe disease, the additional variables unique to an elderly patient warrant consideration when discussing IBD therapeutics. As chronic corticosteroid use, although relatively common among older IBD patients, is suboptimal, the efficacy and safety of biologics compared with immunomodulators among older IBD patients needs additional investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kappelman MD, Rifas-Shiman SL, Porter CQ, et al. Direct health care costs of Crohn’s disease and ulcerative colitis in US children and adults. Gastroenterology. 2008;135:1907–13.

    Article  PubMed  Google Scholar 

  2. 2010 Census Data on Aging. Available at http://www.aoa.gov/aoaroot/aging_statistics/Census_Population/census2010/Index.aspx. Last modified December 5, 2011.

  3. Khalili H, Huang ES, Ananthakrishnan AN, et al. Geographical variation and incidence of inflammatory bowel disease among US women. Gut. 2012;61:1686–92.

    Article  PubMed  Google Scholar 

  4. Loftus EV Jr, Silverstein MD, Sandborn WJ, et al. Ulcerative colitis in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gut. 2000;46:336–43.

    Article  PubMed  Google Scholar 

  5. Loftus EV Jr, Silverstein MD, Sandborn WJ, et al. Crohn’s disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology. 1998;114:1161–8.

    Article  PubMed  Google Scholar 

  6. Charpentier C, Salleron J, Savoye G, et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut. 2013. doi:10.1136/gutjnl-2012-303864.

  7. Quezada SM, Steinberger EK, Cross RK. Association of age at diagnosis and Crohn’s disease phenotype. Age Ageing. 2013;42(1):102–6.

    Google Scholar 

  8. Ha CY, Newberry RD, Stone CD, et al. Patients with late-adult-onset ulcerative colitis have better outcomes than those with early onset disease. Clin Gastroenterol Hepatol. 2010;8(8):682–7.

    Google Scholar 

  9. Juneja M, Baidoo L, Schwartz MB, et al. Geriatric inflammatory bowel disease: phenotypic presentation, treatment patterns, nutritional status, outcomes, and comorbidity. Dig Dis Sci. 2012;57:2408–15.

    Article  PubMed  Google Scholar 

  10. Castle SC. Clinical relevance of age-related immune dysfunction. Clin Infect Dis. 2000;31:578–85.

    Article  PubMed  CAS  Google Scholar 

  11. Pawelec G. Immunosenescence: impact in the young as well as the old? Mech Ageing Dev. 1999;108:1–7.

    Article  PubMed  CAS  Google Scholar 

  12. Cucchiara S, Iebba V, Conte MP, et al. The microbiota in inflammatory bowel disease in different age groups. Dig Dis. 2009;27:252–8.

    Article  PubMed  Google Scholar 

  13. Tourner M, Loftus EV, Harmsen WS, et al. Risk factors for opportunistic infections in patients with inflammatory bowel disease. Gastroenterology. 2008;134:929–36.

    Article  Google Scholar 

  14. Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infection and mortality in patients with Crohn’s disease: more than 5 years of follow-up in the TREAT registry. Am J Gastroenterol. 2012;107(9):1409–22.

    Google Scholar 

  15. Lichtenstein GR, Feagan BG, Cohen RD, et al. Serious infections and mortality in association with therapies for Crohn’s disease: TREAT registry. Clin Gastroenterol Hepatol. 2006;4:621–30.

    Article  PubMed  CAS  Google Scholar 

  16. Ananthakrishnan AN, McGinley EL, Binion DG. Inflammatory bowel disease in the elderly is associated with worse outcomes: a national study of hospitalizations. Inflamm Bowel Dis. 2009;15:182–9.

    Article  PubMed  Google Scholar 

  17. Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103:2272–80.

    Article  PubMed  Google Scholar 

  18. Ananthakrishnan AN, McGinley EL. Infection-related hospitalizations are associated with increased mortality in patients with inflammatory bowel diseases. J Crohns Colitis. 2013;7(2):107–12.

    Google Scholar 

  19. Ananthakrishnan AN, McGinley EL, Binion DG. Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Gut. 2008;57:205–10.

    Article  PubMed  CAS  Google Scholar 

  20. Lichtenstein GR, Yan S, Bala M, et al. Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology. 2005;128:862–9.

    Article  PubMed  CAS  Google Scholar 

  21. Rutgeerts P, Feagan BG, Lichtenstein GR, et al. Comparison of scheduled and episodic treatment strategies of infliximab in Crohn’s disease. Gastroenterology. 2004;126:402–13.

    Article  PubMed  CAS  Google Scholar 

  22. Colombel JF, Sandborn WJ, Reinisch W, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362:1383–95.

    Article  PubMed  CAS  Google Scholar 

  23. Rubin DT, Uluscu O, Sederman R. Response to biologic therapy in Crohn’s disease is improved with early treatment: an analysis of health claims data. Inflamm Bowel Dis. 2012;18:2225–31.

    Article  PubMed  Google Scholar 

  24. Schreiber S, Colombel JF, Bloomfield R, et al. Increased response and remission rates in short-duration Crohn’s disease with subcutaneous certolizumab pegol: an analysis of PRECiSE 2 randomized maintenance trial data. Am J Gastroenterol. 2010;105:1574–82.

    Article  PubMed  CAS  Google Scholar 

  25. Benchimol EI, Cook SF, Erichsen R, et al. International variation in medication prescription rates among elderly patients with inflammatory bowel disease. J Crohns Colitis. 2012. doi:10.1016/j.crohns.2012.09.001.

  26. Cottone M, Kohn A, Daperno M, et al. Advanced age is an independent risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol. 2011;9:30–5.

    Article  PubMed  CAS  Google Scholar 

  27. Desai A, Zator ZA, de Silva P, et al. Older age is associated with higher rate of discontinuation of anti-TNF therapy in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2012;19:309–15.

    Google Scholar 

  28. Moleski S, Lindenmeyer C, Kozuch P. The use of infliximab in older inflammatory bowel disease patients. Gastroenterology. 2012;142:S361.

    Google Scholar 

  29. Bhushan A, Pardi D, Loftus E, et al. Association of age with adverse events from biologic therapy in patients with inflammatory bowel disease. Gastroenterology. 2010;138:A413.

    Google Scholar 

  30. Marehbian J, Arrighi HM, Hass S, et al. Adverse events associated with common therapy regimens for moderate-to-severe Crohn’s disease. Am J Gastroenterol. 2009;104:2524–33.

    Article  PubMed  Google Scholar 

  31. Grijalva CG, Chen L, Delzell E, et al. Initiation of tumor necrosis factor-alpha antagonists and the risk of hospitalization for infection in patients with autoimmune diseases. J Am Med Assoc. 2011;306:2331–9.

    Article  CAS  Google Scholar 

  32. Tran S, Hooker RS, Cipher DJ, et al. Patterns of biologic agent use in older males with inflammatory diseases: an institution-focused, observational post-marketing study. Drugs Aging. 2009;26:607–15.

    Article  PubMed  Google Scholar 

  33. Oei HB, Hooker RS, Cipher DJ, et al. High rates of stopping or switching biological medications in veterans with rheumatoid arthritis. Clin Exp Rheumatol. 2009;27:926–34.

    PubMed  CAS  Google Scholar 

  34. Ha CY, Katz S. Clinical outcomes and management of inflammatory bowel disease in the older patient. Curr Gastroenterol Rep. 2013;15:310.

    Article  PubMed  Google Scholar 

  35. Baddley JW, Winthrop KL, Patkar NM, et al. Geographic distribution of endemic fungal infections among older persons, United States. Emerg Infect Dis. 2011;17:1664–9.

    Article  PubMed  Google Scholar 

  36. Widdifield J, Bernatsky S, Michael Paterson J, et al. Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis. Arthritis Care Res. 2013;65(3):353-61.

    Google Scholar 

  37. Long MD, Martin CF, Pipkin CA, et al. Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease. Gastroenterology. 2012;143(390–399):e1.

    PubMed  Google Scholar 

  38. Wolfe F, Michaud K. Biologic treatment of rheumatoid arthritis and the risk of malignancy: analyses from a large US observational study. Arthritis Rheum. 2007;56:2886–95.

    Article  PubMed  Google Scholar 

  39. Peyrin-Biroulet L, Khosrotehrani K, Carrat F, et al. Increased risk for nonmelanoma skin cancers in patients who receive thiopurines for inflammatory bowel disease. Gastroenterology. 2011;141:1621–28. e1–5.

    Google Scholar 

  40. Beaugerie L, Carrat F, Bouvier AM, et al. Excess risk of lymphoproliferative disorders (LPD) in inflammatory bowel disease (IBD): interim results of the CESAME cohort. Gastroenterology. 2008;134:A116–7.

    Article  Google Scholar 

  41. Long MD, Herfarth HH, Pipkin CA, et al. Increased risk for non-melanoma skin cancer in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2010;8:268–74.

    Article  PubMed  Google Scholar 

  42. Dixon WG, Watson KD, Lunt M, et al. Influence of anti-tumor necrosis factor therapy on cancer incidence in patients with rheumatoid arthritis who have had a prior malignancy: results from the British Society for Rheumatology Biologics Register. Arthritis Care Res. 2010;62:755–63.

    Article  CAS  Google Scholar 

  43. Raaschou P, Simard JF, Neovius M, et al. Does cancer that occurs during or after anti-tumor necrosis factor therapy have a worse prognosis? A national assessment of overall and site-specific cancer survival in rheumatoid arthritis patients treated with biologic agents. Arthritis Rheum. 2011;63:1812–22.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Funding source

None.

Author information

Authors and Affiliations

  1. Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Christina Ha

  2. Division of Gastroenterology, NYU Langone Medical Center, New York, NY, USA

    Seymour Katz

Authors
  1. Christina Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seymour Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christina Ha.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ha, C., Katz, S. Management of Inflammatory Bowel Disease in the Elderly: Do Biologicals Offer A Better Alternative?. Drugs Aging 30, 871–876 (2013). https://doi.org/10.1007/s40266-013-0120-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-013-0120-x

Keywords

Search

Navigation