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Older people with bowel disease receive older medicines

November 13, 2017

Inflammatory bowel disease is common amongst older people and there are big differences in the choice of treatment for different age groups. Patients over the age of 60 often receive cortisone drugs instead of more modern medicines that target the immune system. This according to a large registry study from Karolinska Institutet in Sweden published in Gastroenterology.

Inflammatory bowel disease includes Crohn's disease, which can affect the whole intestine, and ulcerative colitis, which affects the colon and rectum. Symptoms include blood in the stool, diarrhoea and stomach pain. Treatment consists of anti-inflammatory drugs and surgery to remove the damaged part of the intestines. The most common age of onset is 20-30, and previous studies have claimed that it is uncommon for the disease to debut over the age of 60 and when it does, it is less severe.

"We therefore sought to ascertain the incidence of inflammatory bowel disease in older age groups and if there is any difference in how they are treated and how they use the healthcare services," says Åsa Hallqvist Everhov, researcher at Karolinska Institutet's Department of Clinical Research and Education, Stockholm South General (Söder) Hospital (KI SÖS) and colorectal surgeon at the same hospital.

The study included all new cases of inflammatory bowel disease in Sweden between 2006 and 2014. The resulting group of just under 28,000 patients was split into three sub-groups depending on year of onset: childhood (<18), adult (18-59) and old adult (?60). Data were sourced from the National Board of Health and Welfare's patients and prescribed drugs registers, subject to a maximum monitoring period of nine years. The researchers compared the patients' healthcare consumption with that of a matched group selected from the general population.

Just over one fifth of the participants were over 60. The study also shows that this group consumed more healthcare than the two younger groups and more than their matched peers without inflammatory bowel disease. They were also operated on more often and sooner after disease onset, often already within the first year.

"It's common, in other words, for the disease to onset after the age of 60 and we found no evidence that when it does, the disease progress is milder," says Dr Hallqvist Everhov.

One important finding was the big difference in medication between the age groups. More younger patients received modern immunomodulating drugs and TNF inhibitors, whereas older cortisone drugs were more commonly given to the older patients.

"We don't know the reason for this, but it could be due either to under-prescription to older sufferers or to prudent choice, since the newer drugs carry certain risks and side-effects," continues Dr. Hallqvist Everhov. "Older patients often already have other potent drugs."

The researchers plan to examine the causes of the treatment discrepancies in a new study.
The study was conducted in association with Söder Hospital. Linköping University, Örebro University, the University of Nottingham, Columbia University College of Physicians and Surgeons and Sachs' Children and Youth Hospital.

The research was supported by the Swedish society of medicine, Mag-tarmfonden, the Jane and Dan Olsson foundation, the Mjölkdroppen foundation, The Swedish Foundation for Strategic Research, The Swedish Research Council, The Swedish Cancer Society, The Bengt Ihre research fellowship in gastroenterology, The Bengt Ihre foundation, Karolinska Institutet foundations, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet (ALF). The study also received an unrestricted grant by Janssen Pharmaceutica NV. The authors declare no conflicts of interest.

Publication: "Incidence and treatment of patients diagnosed with inflammatory bowel diseases at 60 years or older in Sweden", Åsa Hallqvist Everhov, Jonas Halfvarson, Pär Myrelid, Michael C Sachs, Caroline Nordenvall, Jonas Söderling, Anders Ekbom, Martin Neovius, Jonas F Ludvigsson, Johan Askling, Ola Olén. Gastroenterology, online 1 November 2017.

Karolinska Institutet

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