Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia.
Faculty of Medicine, University of Sydney, Sydney, Australia.
Inflamm Bowel Dis. 2019 Jul 17;25(8):1390-1398. doi: 10.1093/ibd/izy389.
The use of immunomodulators (IMs) is often avoided in elderly patients with inflammatory bowel disease (IBD) due to concerns about complications. Our aim is to compare the use of IMs in elderly and younger patients with Crohn's disease (CD) or ulcerative colitis (UC) and identify markers that predict their use.
In this retrospective cohort study, patients diagnosed with IBD from 1970 to 2009 were recruited from the "Sydney IBD Cohort." Patients diagnosed at age 60 years old or older and between 16 and old 40 years were classified as "elderly-onset" and "young-onset" respectively.
A total of 255 elderly-onset patients (115 CD, 140 UC) and 1244 young-onset patients (657 CD, 587 UC) were recruited. Most elderly-onset patients had colonic CD (61.4%), whereas young-onset patients had predominantly ileocolonic CD (42.8%, P < 0.0001). Left-sided UC was the most common disease localization for both elderly-onset (52.1%) and young-onset patients (42.2%, P = 0.013). The cumulative probability of IM exposure at 5 years post-diagnosis was significantly less in elderly-onset patients compared with young-onset patients for CD (20.0% vs 33.4%, P = 0.0002) and UC (7.8% vs 13.4%, P = 0.0007). Age at diagnosis was not associated with the time to IMs introduction. Charlson Comorbidity Index was shown to delay IM introduction in CD (hazard ratio [HR] 0.863; 95% CI, 0.787-0.946; P = 0.002) and UC (HR 0.807; 95% CI, 0.711-0.917; P = 0.001). Early IM use was associated with reduced need for abdominal and perianal surgery in CD (HR 0.177; 95% CI, 0.089-0.351; P < 0.0001).
Comorbidity and not age at diagnosis is associated with IM introduction. Early IM is associated with reduced surgery in both young- and elderly-onset CD but not UC.
由于担心并发症，免疫调节剂（IMs）在老年炎症性肠病（IBD）患者中通常被避免使用。我们的目的是比较老年和年轻克罗恩病（CD）或溃疡性结肠炎（UC）患者中 IMs 的使用情况，并确定预测其使用的标志物。
本回顾性队列研究招募了 1970 年至 2009 年间诊断为 IBD 的患者，这些患者来自“悉尼 IBD 队列”。60 岁及以上和 16 至 40 岁之间被诊断为患者分别归类为“老年发病”和“年轻发病”。
共招募了 255 名老年发病患者（115 名 CD，140 名 UC）和 1244 名年轻发病患者（657 名 CD，587 名 UC）。大多数老年发病患者为结肠 CD（61.4%），而年轻发病患者则以回结肠 CD 为主（42.8%，P < 0.0001）。左半结肠炎是老年发病（52.1%）和年轻发病患者（42.2%，P = 0.013）中最常见的疾病定位。与年轻发病患者相比，老年发病患者在诊断后 5 年内使用 IM 的累积概率显著降低，CD（20.0% vs 33.4%，P = 0.0002）和 UC（7.8% vs 13.4%，P = 0.0007）。诊断时的年龄与 IM 引入时间无关。Charlson 合并症指数显示，CD（风险比 [HR] 0.863；95%CI，0.787-0.946；P = 0.002）和 UC（HR 0.807；95%CI，0.711-0.917；P = 0.001）的 IM 引入时间延迟。早期 IM 治疗与 CD 中减少腹部和肛周手术的需求相关（HR 0.177；95%CI，0.089-0.351；P < 0.0001）。
合并症而不是诊断时的年龄与 IM 引入有关。年轻和老年发病的 CD 患者早期使用 IM 与减少手术有关，但 UC 患者则没有。
