Department of Adult Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada.
Department of Medicine, McGill University Health Centre, Montreal, QC H3G 1A4, Canada.
World J Gastroenterol. 2019 Aug 14;25(30):4158-4171. doi: 10.3748/wjg.v25.i30.4158.
High-quality data remains scarce in terms of optimal management strategies in the elderly inflammatory bowel disease (IBD) population. Indeed, available trials have been mostly retrospective, of small sample size, likely owing to under-representation of such a population in the major randomized controlled trials. However, in the last five years, there has been a steady increase in the number of published trials, helping clarify the estimated benefits and toxicity of the existing IBD armamentarium. In the Everhov trial, prescription strategies were recorded over an average follow-up of 4.2 years. A minority of elderly IBD patients (1%-3%) were treated with biologics within the five years following diagnosis, whilst almost a quarter of these patients were receiving corticosteroid therapy at year five of follow-up, despite its multiple toxicities. The low use of biologic agents in real-life settings likely stems from limited data suggesting lower efficacy and higher toxicity. This minireview will aim to highlight current outcome measurements as it portends the elderly IBD patient, as well as summarize the available therapeutic strategies in view of a growing body of evidence.
关于老年炎症性肠病（IBD）患者的最佳管理策略，高质量的数据仍然稀缺。事实上，现有的试验大多是回顾性的，样本量较小，这可能是由于此类人群在主要的随机对照试验中代表性不足。然而，在过去五年中，发表的试验数量稳步增加，有助于阐明现有 IBD 武器库的估计益处和毒性。在 Everhov 试验中，记录了平均随访 4.2 年的处方策略。在诊断后的五年内，只有 1%-3%的老年 IBD 患者接受了生物制剂治疗，而尽管皮质类固醇治疗具有多种毒性，但几乎四分之一的患者在随访的第五年仍在接受皮质类固醇治疗。在现实环境中，生物制剂的使用较少可能源于数据有限，表明其疗效较低，毒性较高。这篇迷你综述旨在强调当前的结果测量方法，因为它预示着老年 IBD 患者，同时鉴于越来越多的证据，总结了可用的治疗策略。
