Advanced Therapies in Elderly Patients With Inflammatory Bowel Disease: A Comparative Retrospective Cohort Study in Taiwan

Shih-Hua Lin,1– 3 Horng-Yih Chiu,2 Chia-Jung Kuo,2– 6 Chien-Ming Chen,7 Ming-Yao Su,1– 3 Ren-Chin Wu,8 Cheng-Tang Chiu,2– 6 Chen-Wang Chang,3,9 Chen-Shuan Chung,3,10 Yu-Bin Pan,11 Puo-Hsien Le2– 6 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, Tucheng, New Taipei City, Taiwan; 2School of Medicine, Chang Gung University, Taoyuan City, Taiwan; 3Taiwan Association for the Study of Intestinal Diseases (TASID), Taoyuan City, Taiwan; 4Chang Gung Inflammatory Bowel Disease Center, Linkou, Taoyuan, Taiwan; 5Chang Gung Microbiota Therapy Center, Linkou, Taoyuan, Taiwan; 6Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; 7Department of Medical Imaging and Interventions, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; 8Department of Anatomic Pathology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; 9Department of Gastroenterology and Hepatology, Mackay Memorial Hospital, Taipei, Taiwan; 10Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 11Biostatistical Section, Clinical Trial Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, TaiwanCorrespondence: Puo-Hsien Le, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Branch, 5, Fu-Hsin Street, Guei-Shan District, Taoyuan City, 33305, Taiwan, Tel +886-3-3281200 ext 8101, Fax +886-3-3272236, Email [email protected]: Inflammatory Bowel Disease (IBD) predominantly affects younger individuals, but emerging data indicates a shift toward older populations. Elderly-onset IBD (diagnosed at 60 years or older) differs from younger-onset IBD, presenting with atypical symptoms and higher risks of infections and malignancies. However, drug persistence is underexplored in the elderly IBD group, warranting further investigation to optimize treatment strategies for this demographic.Patients and Methods: This retrospective cohort study included IBD patients receiving advanced therapies at the Chang Gung IBD Center from October 2017 to September 2023. Patients were stratified into two groups: elderly-onset (≥ 60 years) and control (< 60 years). We compared one-year persistence of advanced therapies, opportunistic infections, IBD-related admissions, complications, surgeries, and acute flare-ups between the groups. Specifically, we analyzed the one-year persistence of various advanced therapies within the elderly-onset cohort.Results: The study included 511 IBD patients, 107 of whom were elderly-onset. Elderly-onset patients had a higher body mass index, a higher proportion of ulcerative colitis, fewer smokers, and lower levels of white blood cells, hemoglobin, and albumin. Differences were noted in Montreal classifications and a higher use of Vedolizumab. Clinical outcomes, including steroid-free remission rates, one-year therapy persistence, infections, complications, surgeries, and flare-ups, were comparable between groups. In Crohn’s disease (CD), Infliximab and Ustekinumab exhibited higher one-year persistence. Predictors of one-year therapy persistence included Montreal L1 (OR: 6.722; 95% CI: 1.296– 34.852; P=0.023), Ustekinumab use (OR: 5.672; 95% CI: 1.138– 28.267; P=0.034), and hemoglobin level (OR: 1.612; 95% CI: 1.210– 2.147; P=0.001) with an optimal cutoff of 11.65 g/dL.Conclusion: Elderly-onset IBD patients display unique clinical characteristics and therapy persistence, particularly in CD, highlighting the necessity for customized therapeutic strategies.Keywords: elderly-onset inflammatory bowel disease, advanced therapies, drug persistence, clinical outcomes