Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Department of Gastroenterology, Singapore General Hospital, Singapore.
Eur J Gastroenterol Hepatol. 2020 Aug;32(8):976-983. doi: 10.1097/MEG.0000000000001768.
Comorbidities, polypharmacy, malignancies, and infections complicate management of elderly patients with inflammatory bowel diseases (IBD). This study assessed gastroenterologists' preference in the prescription of medications or surgery to elderly patients with IBD, and the factors associated with their choices.
An international case-based survey was conducted that presented three cases of steroid-dependent ulcerative colitis assessing young-age versus elderly-age patients, with and without comorbidity. Physician characteristics and practice demographics were collected. Factors associated with selection of different choices of therapy were determined by logistic regression analysis.
A total of 424 respondents from 41 countries were included. Vedolizumab (53.2%) and thiopurines (19.4%) were the top treatment preferences for moderate-to-severe ulcerative colitis (P < 0.0001). Comorbidity and older age were independently associated with more frequent use of vedolizumab (P < 0.0001), and less frequent use of immunomodulators and anti-tumour necrosis factor (TNF; P < 0.0001). Comorbidity was the only independent predictor for selecting colectomy (P < 0.0001). A history of lymphoma (94%) and opportunistic infection (78.3%) were the most frequent conditions precluding the use of thiopurine and anti-TNF in elderly patients with IBD. Only 6.1% of respondents considered patient age a limit for vedolizumab, while 37.9% considered age as a limiting factor in prescribing thiopurines (P < 0.001). Geographical heterogeneity was identified with significantly more physicians from Oceania and North America favouring the use of vedolizumab.
Vedolizumab was the preferred first-line agent in the treatment of elderly patients with IBD with steroid-dependent moderate-to-severe ulcerative colitis. Older age and presence of comorbidity influenced the selection of medication. Comorbidity was the main predictor of colectomy. Geographical heterogeneity in prescribing habits may relate to medication reimbursement in individual countries.
合并症、多种药物治疗、恶性肿瘤和感染使老年炎症性肠病（IBD）患者的管理复杂化。本研究评估了胃肠病医生对老年 IBD 患者药物治疗或手术的偏好，以及与这些选择相关的因素。
进行了一项国际基于病例的调查，提出了三种类固醇依赖性溃疡性结肠炎的病例，评估了年轻和老年患者，以及有无合并症。收集了医生的特征和实践人口统计学数据。通过逻辑回归分析确定了不同治疗选择的选择相关因素。
共纳入来自 41 个国家的 424 名受访者。对于中重度溃疡性结肠炎，vedolizumab（53.2%）和硫嘌呤（19.4%）是首选治疗方法（P<0.0001）。合并症和年龄较大与更频繁使用 vedolizumab 独立相关（P<0.0001），而更频繁使用免疫调节剂和抗肿瘤坏死因子（TNF；P<0.0001）。合并症是选择结肠切除术的唯一独立预测因素（P<0.0001）。淋巴瘤病史（94%）和机会性感染（78.3%）是老年 IBD 患者禁用硫嘌呤和抗 TNF 的最常见情况。只有 6.1%的受访者认为患者年龄是 vedolizumab 的限制因素，而 37.9%的受访者认为年龄是开具硫嘌呤的限制因素（P<0.001）。存在明显的地域差异，来自大洋洲和北美的医生更倾向于使用 vedolizumab。
vedolizumab 是治疗老年 IBD 患者类固醇依赖性中重度溃疡性结肠炎的首选一线药物。年龄较大和合并症影响药物的选择。合并症是结肠切除术的主要预测因素。处方习惯的地域差异可能与个别国家的药物报销有关。
