Frailty risk and treatment strategy in elderly-onset inflammatory bowel disease. A Norwegian nationwide population-based registry study.

Background/aims: To determine real-world medical and surgical treatment patterns in elderly-onset inflammatory bowel disease in a nationwide cohort, and to investigate associations between frailty and treatment choices.
Methods: Norwegian health registries were used to identify adult-onset (born 1950-1989) and elderly-onset (born 1910-1949) patients with Crohn's disease (CD) and ulcerative colitis (UC) diagnosed 2010-2017 (n = 13,006). Patients were classified as no, low and intermediate/high frailty risk after the Hospital Frailty Risk Score. Outcomes included use of medical and surgical treatment.
Results: Within five years, elderly-onset patients received less biologics (13% [CD], 7% [UC]) and immunomodulators (24% [CD], 11% [UC]), and major surgery was more frequent (22% [CD], 9% [UC]) than in adult-onset. Respective log rank tests were significant (p < 0.01). Compared to no frailty risk groups, elderly-onset UC with intermediate/high frailty risk had lower probability of starting biologics (4% versus 9%), immunomodulators (7% versus 13%) and 5-aminosalisylic acids (66% versus 84%), and elderly-onset CD with intermediate/high frailty risk had higher probability of starting prednisolone (67% versus 49%). Respective log rank tests were significant (p < 0.05).
Conclusions: Elderly-onset patients received less biologics and immunomodulators and a larger proportion underwent major surgery. Frailty risk in elderly-onset patients was associated with increased use of prednisolone, and less use of 5-aminosalisylic acids, immunomodulators and biologics.
Competing Interests: Conflict of interest K.A. reports consultant fees from Takeda outside the submitted work. S.S.L. reports grants and consultant fees from Takeda. A.W.M. reports grants from Takeda. B.M. reports consultant fees from Takeda, Janssen, AbbVie, Galapagos, Pfizer, Sandoz, Pharmacosmos as, Ferring as, Tillotts Pharma; speaker fees from Takeda, Janssen, Pfizer, AbbVie, Sandoz, Orion Pharma, Ferring as, Tillotts Pharma. H.O.M. reports grants and consultant fees from Takeda. M.L.H. reports speaker fees from Galapagos, Ferring, BMS, Janssen, AbbVie, Meda, Tillotts and Takeda; advisory boards for Takeda, Galapagos, BMS and AbbVie; investigator-initiated research grants from: Takeda, Pfizer, Tillotts and Ferring.
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