Lin Shih-Hua, Chiu Horng-Yih, Kuo Chia-Jung, Chen Chien-Ming, Su Ming-Yao, Wu Ren-Chin, Chiu Cheng-Tang, Chang Chen-Wang, Chung Chen-Shuan, Pan Yu-Bin, Le Puo-Hsien
Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, Tucheng, New Taipei City, Taiwan.
School of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Ther Clin Risk Manag. 2025 Apr 25;21:533-542. doi: 10.2147/TCRM.S518405. eCollection 2025.
PURPOSE: Inflammatory Bowel Disease (IBD) predominantly affects younger individuals, but emerging data indicates a shift toward older populations. Elderly-onset IBD (diagnosed at 60 years or older) differs from younger-onset IBD, presenting with atypical symptoms and higher risks of infections and malignancies. However, drug persistence is underexplored in the elderly IBD group, warranting further investigation to optimize treatment strategies for this demographic. PATIENTS AND METHODS: This retrospective cohort study included IBD patients receiving advanced therapies at the Chang Gung IBD Center from October 2017 to September 2023. Patients were stratified into two groups: elderly-onset (≥60 years) and control (<60 years). We compared one-year persistence of advanced therapies, opportunistic infections, IBD-related admissions, complications, surgeries, and acute flare-ups between the groups. Specifically, we analyzed the one-year persistence of various advanced therapies within the elderly-onset cohort. RESULTS: The study included 511 IBD patients, 107 of whom were elderly-onset. Elderly-onset patients had a higher body mass index, a higher proportion of ulcerative colitis, fewer smokers, and lower levels of white blood cells, hemoglobin, and albumin. Differences were noted in Montreal classifications and a higher use of Vedolizumab. Clinical outcomes, including steroid-free remission rates, one-year therapy persistence, infections, complications, surgeries, and flare-ups, were comparable between groups. In Crohn's disease (CD), Infliximab and Ustekinumab exhibited higher one-year persistence. Predictors of one-year therapy persistence included Montreal L1 (OR: 6.722; 95% CI: 1.296-34.852; P=0.023), Ustekinumab use (OR: 5.672; 95% CI: 1.138-28.267; P=0.034), and hemoglobin level (OR: 1.612; 95% CI: 1.210-2.147; P=0.001) with an optimal cutoff of 11.65 g/dL. CONCLUSION: Elderly-onset IBD patients display unique clinical characteristics and therapy persistence, particularly in CD, highlighting the necessity for customized therapeutic strategies.
目的：炎症性肠病（IBD）主要影响年轻人，但新出现的数据表明发病有向老年人群转移的趋势。老年起病的IBD（60岁及以上确诊）与年轻起病的IBD不同，表现为非典型症状以及感染和恶性肿瘤风险更高。然而，老年IBD患者群体的药物持续使用情况尚未得到充分研究，需要进一步调查以优化该人群的治疗策略。 患者与方法：这项回顾性队列研究纳入了2017年10月至2023年9月在长庚IBD中心接受先进治疗的IBD患者。患者被分为两组：老年起病组（≥60岁）和对照组（<60岁）。我们比较了两组之间先进治疗的一年持续使用情况、机会性感染、IBD相关住院、并发症、手术和急性发作情况。具体而言，我们分析了老年起病队列中各种先进治疗的一年持续使用情况。 结果：该研究纳入了511例IBD患者，其中107例为老年起病。老年起病患者的体重指数更高，溃疡性结肠炎比例更高，吸烟者更少，白细胞、血红蛋白和白蛋白水平更低。在蒙特利尔分类以及维多珠单抗的更高使用方面存在差异。两组之间的临床结局，包括无类固醇缓解率、一年治疗持续率、感染、并发症、手术和发作情况相当。在克罗恩病（CD）中，英夫利昔单抗和优特克单抗的一年持续使用率更高。一年治疗持续率的预测因素包括蒙特利尔L1（比值比：6.722；95%置信区间：1.296 - 34.852；P = 0.023）、优特克单抗的使用（比值比：5.672；95%置信区间：1.138 - 28.267；P = 0.034）以及血红蛋白水平（比值比：1.612；95%置信区间：1.210 - 2.147；P = 0.001），最佳临界值为11.65 g/dL。 结论：老年起病的IBD患者表现出独特的临床特征和治疗持续情况，尤其是在CD中，这凸显了制定个性化治疗策略的必要性。
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