Abstract
Ulcerative colitis (UC) in patients aged > 60 years is increasingly common. The treatment of UC aims to induce and maintain clinical remission, with 5-aminosalicylates the mainstay for mild UC. In moderate-to-severe or refractory UC, oral corticosteroids, thiopurines, anti-TNF agents, vedolizumab and tofacitinib are treatment options to induce and/or maintain remission. To facilitate compliance and minimize adverse drug events, treatment should be tailored to patients’ general health status, comorbidities and existing medications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Shrestha MP, Taleban S. Management of ulcerative colitis in the elderly. Drugs Aging. 2019;36(1):13–27.
Loftus CG, Loftus EV Jr, Harmsen WS, et al. Update on the incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted county, Minnesota, 1940–2000. Inflamm Bowel Dis. 2007;13(3):254–61.
Matsumoto S, Miyatani H, Yoshida Y. Ulcerative colitis: comparison between elderly and young adult patients and between elderly patients with late-onset and long-standing disease. Dig Dis Sci. 2013;58(5):1306–12.
Sturm A, Maaser C, Mendall M, et al. European Crohn’s and Colitis Organisation topical review on IBD in the elderly. J Crohns Colitis. 2017;11(3):263–73.
Katz S, Surawicz C, Pardi DS. Management of the elderly patients with inflammatory bowel disease: practical considerations. Inflamm Bowel Dis. 2013;19(10):2257–72.
Gisbert JP, Gonzalez-Lama Y, Mate J. 5-aminosalicylates and renal function in inflammatory bowel disease: a systematic review. Inflamm Bowel Dis. 2007;13(5):629–38.
Kim M, Katz S, Green J. Drug management in the elderly IBD patient. Curr Treat Options Gastroenterol. 2015;13(1):90–104.
Muller AF, Stevens PE, McIntyre AS, et al. Experience of 5-aminosalicylate nephrotoxicity in the United Kingdom. Aliment Pharmacol Ther. 2005;21(10):1217–24.
Pardi DS, Loftus EV Jr, Camilleri M. Treatment of inflammatory bowel disease in the elderly: an update. Drugs Aging. 2002;19(5):355–63.
Lichtenstein GR, Travis S, Danese S, et al. Budesonide MMX for the induction of remission of mild to moderate ulcerative colitis: a pooled safety analysis. J Crohns Colitis. 2015;9(9):738–46.
Alexakis C, Saxena S, Chhaya V, et al. Do thiopurines reduce the risk of surgery in elderly onset inflammatory bowel disease? A 20-year national population-based cohort study. Inflamm Bowel Dis. 2017;23(4):672–80.
Benchimol EI, Cook SF, Erichsen R, et al. International variation in medication prescription rates among elderly patients with inflammatory bowel disease. J Crohns Colitis. 2013;7(11):878–89.
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(1):30–5.
Lobatόn T, Ferrante M, Rutgeerts P, et al. Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2015;42(4):441–51.
Feagan BG, Rutgeerts P, Sands BE, et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2013;369(8):699–710.
Navaneethan U, Edminister T, Zhu X, et al. Vedolizumab is safe and effective in elderly patients with inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(4):E17.
Sandborn WJ, Su C, Sands BE, et al. Tofacitinib as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2017;376(18):1723–36.
Moskovitz DN, Van Assche G, Maenhout B, et al. Incidence of colectomy during long-term follow-up after cyclosporine induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol. 2006;4(6):760–5.
Parian A, Ha CY. Older age and steroid use are associated with increasing polypharmacy and potential medication interactions among patients with inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(6):1392–400.
Kane SV. Systematic review: adherence issues in the treatment of ulcerative colitis. Aliment Pharmacol Ther. 2006;23(5):577–85.
Bewtra M, Newcomb CW, Wu Q, et al. Mortality associated with medical therapy versus elective colectomy in ulcerative colitis: a cohort study. Ann Intern Med. 2015;163(4):262–70.
Van Assche G, Dignass A, Bokemeyer B, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations. J Crohns Colitis. 2013;7(1):1–33.
Shaukat A, Virnig DJ, Salfiti NI, et al. Is inflammatory bowel disease an important risk factor among older persons with colorectal cancer in the United States? A population-based case-control study. Dig Dis Sci. 2011;56(8):2378–83.
Author information
Authors and Affiliations
Consortia
Ethics declarations
Funding
The preparation of this review was not supported by any external funding.
Conflict of interest
The article was adapted from Drugs & Aging 2019; 36(1):13–27 [1] by employees of Adis International Ltd/Springer Nature, who are responsible for the article content and declare no conflicts of interest.
Rights and permissions
About this article
Cite this article
Adis Medical Writers. When managing ulcerative colitis in older patients, understanding their overall health profile is key. Drugs Ther Perspect 35, 369–373 (2019). https://doi.org/10.1007/s40267-019-00647-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40267-019-00647-3