Geisz Matthew, Ha Christina, Kappelman Michael D, Martin Christopher F, Chen Wenli, Anton Kristen, Sandler Robert S, Long Millie D
*University of North Carolina at Chapel Hill School of Medicine; †Department of Medicine, Division of Gastroenterology and Hepatology, University of California, Los Angeles, California; ‡Center for Gastrointestinal Biology and Disease, Chapel Hill, North Carolina; §Department of Pediatrics, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ‖Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and ¶Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Inflamm Bowel Dis. 2016 Jun;22(6):1435-41. doi: 10.1097/MIB.0000000000000747.
Older individuals with inflammatory bowel disease (IBD) require ongoing medications. We aimed to describe (1) medication use in older and younger IBD patients and (2) medication associations with patient reported outcomes (PROs) in older patients.
We conducted cross-sectional and longitudinal analyses within CCFA Partners internet-based cohort of patients with self-reported IBD. We assessed medication use by disease sub-type and age. We used bivariate analyses to (1) compare medication use in older and younger patients and (2) determine associations between continued steroid use and patient reported outcomes in older patients.
We included 5382 participants with IBD; 1004 were older (≥age 60). Older patients with Crohn's disease (CD) had lower antitumor necrosis factor alpha (anti-TNF) use at baseline (29.1% versus 44.3%, P < 0.001), comparable steroid use (16.0% versus 16.5%, P = 0.77), and higher aminosalicylate use (40.3% versus 33.9%, P = 0.003) versus younger patients. Older ulcerative colitis (UC) patients had similar anti-TNF use (16.0% versus 19.2%, P = 0.16), lower steroid use (9.6% versus 15.4%, P = 0.004), and higher aminosalicylate use (73.8% versus 68.2%, P = 0.04) at baseline. In longitudinal analyses, older CD patients had higher continued steroid use (11.6% versus 7.8%, P = 0.002); which was associated with worsened anxiety (P = 0.02), sleep (P = 0.01), and fatigue (P = 0.001) versus nonuse. Older CD patients on steroids, versus anti-TNF or immunomodulators, had increased depression (P = 0.04) and anxiety (P = 0.03).
Medication utilization differs in older patients with IBD. Older CD patients have higher continued steroid use associated with worsened patient reported outcomes. As in younger IBD populations, continued steroid use should be limited in older patients.
患有炎症性肠病（IBD）的老年人需要持续用药。我们旨在描述（1）老年和年轻IBD患者的用药情况，以及（2）老年患者用药与患者报告结局（PROs）之间的关联。
我们在CCFA Partners基于互联网的自我报告IBD患者队列中进行了横断面和纵向分析。我们按疾病亚型和年龄评估用药情况。我们使用双变量分析来（1）比较老年和年轻患者的用药情况，以及（2）确定老年患者持续使用类固醇与患者报告结局之间的关联。
我们纳入了5382名IBD参与者；1004名年龄较大（≥60岁）。与年轻患者相比，老年克罗恩病（CD）患者基线时抗肿瘤坏死因子α（抗TNF）的使用较低（29.1%对44.3%，P<0.001），类固醇使用相当（16.0%对16.5%，P = 0.77），氨基水杨酸酯使用较高（40.3%对33.9%，P = 0.003）。老年溃疡性结肠炎（UC）患者基线时抗TNF使用相似（16.0%对19.2%，P = 0.16），类固醇使用较低（9.6%对15.4%，P = 0.004），氨基水杨酸酯使用较高（73.8%对68.2%，P = 0.04）。在纵向分析中，老年CD患者持续使用类固醇的比例较高（11.6%对7.8%，P = 0.002）；与未使用者相比，这与焦虑加剧（P = 0.02）、睡眠（P = 0.01）和疲劳（P = 0.001）相关。与使用抗TNF或免疫调节剂的老年CD患者相比，使用类固醇的患者抑郁（P = 0.04）和焦虑（P = 0.03）增加。
老年IBD患者的用药情况有所不同。老年CD患者持续使用类固醇的比例较高，这与患者报告结局恶化相关。与年轻IBD人群一样，老年患者应限制类固醇的持续使用。
