Effectiveness and Safety Outcomes in IBD Patients Over the Age of 60 Treated With Biologic or Small Molecule Therapies

Background: Inflammatory bowel disease (IBD) is a complex immune-mediated chronic gastrointestinal disease affecting individuals of all ages. However, despite the increasing prevalence of IBD among the older adult population, studies examining IBD management often exhibit significant underrepresentation of this age group. This study aims to analyze effectiveness and safety outcomes in IBD patients aged 60 and older. Methods: This is a retrospective study of patients with Crohn’s disease (CD) and ulcerative colitis (UC), seen at a tertiary IBD referral center from 2014 onwards, age 60 years and older who were started on biologic or small molecule therapy. Outcomes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fecal calprotectin, clinical response based on Harvey-Bradshaw Index (HBI) and partial Mayo scores and endoscopic improvement based on Simple Endoscopic Severity-CD (SES-CD) and Mayo scoring were collected within one year prior to and one year after starting therapy. Adverse events related to their IBD and therapy including infection, hospitalizations, surgeries, and malignancy were recorded. Microsoft excel was used to compute all calculations. Results: Fifty patients were identified who met inclusion criteria (35 CD, 15 UC), 25 male and 25 female, mean age at drug initiation of 68 years (range: 60-76), twenty-nine patients were between age 60-70 and twenty-one were > 70 years old. Mean BMI 27.5 (range: 18.7-41.1). Mean duration of therapy was 29.5 months (range: 1-132). Medications included ustekinumab (18), vedolizumab (11), infliximab (10), adalimumab (4), tofacitinib (3), risankizumab (3), upadacitinib (1). Labs prior to therapy initiation: ESR (n=26, mean: 20, range: 2-53), CRP (n=24, mean: 8.3, range: 0.2-69.8), fecal calprotectin (n=14, mean: 1295.7, range: 8-8,000), HBI score (n=35, mean: 8, range: 0-22), partial Mayo score (n=15, mean: 4.6, range: 0-8). Labs post therapy initiation: ESR (n=26, mean: 11.2, range: 2-28), CRP (n=23, mean: 6.4, range: .2-77.5), fecal calprotectin (n=13, mean: 928.4, range: 14-3,490), HBI score (n=35, mean: 5.4, range: 0-19), partial Mayo score (n=15, mean: 2.5, range: 0-8). Among sixteen patients with both pre and post initiation therapy colonoscopy data available, most had an overall decrease in scoring after drug initiation: SES-CD for CD (delta mean: 2, range: -2-6), Mayo score for UC (delta mean: 0.3, range: 2-8). 8% experienced a drug related complication, 16% experienced disease related hospitalization and 32% required steroid usage during treatment period. Based off the HBI, nineteen CD patients achieved clinical remission defined as an overall HBI < 5. Based off the partial Mayo score, six UC patients achieved clinical remission defined as score < 2. Conclusions: Most studies and clinical trials in IBD primarily focus on younger cohorts, leading to a significant knowledge gap regarding IBD treatment in older individuals. Our study revealed improvement in all outcomes measured including biomarkers, labs, endoscopy scores, a 50% clinical remission rate and 62% clinical response rate after starting therapy. Safety complications such as infection, hospitalization or malignancy were rare. This data is encouraging but future larger studies are warranted.