Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2019; 25(30): 4158-4171
Published online Aug 14, 2019. doi: 10.3748/wjg.v25.i30.4158
Elderly patients with inflammatory bowel disease: Updated review of the therapeutic landscape
Jean-Frédéric LeBlanc, Daniel Wiseman, Peter L Lakatos, Talat Bessissow
Jean-Frédéric LeBlanc, Peter L Lakatos, Talat Bessissow, Department of Adult Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
Daniel Wiseman, Department of Medicine, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
Peter L Lakatos, 1st Department of Medicine, Semmelweis University, Budapest 1083, Hungary
Author contributions: All co-authors have contributed equally to this article.
Conflict-of-interest statement: LeBlanc JF and Wiseman D have no conflicts of interest. Lakatos PL has been a speaker and/or advisory board member: AbbVie, Arena Pharmaceuticals, Celltrion, Falk Pharma GmbH, Ferring, Genetech, Janssen, Merck, Pharmacosmos, Pfizer, Roche, Shire and Takeda and has received unrestricted research grant: AbbVie, MSD and Pfizer. Bessissow T has received honoraria and acted as a consultant for Janssen, AbbVie, Takeda, Merck, Pfizer, Ferring and Shire
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Talat Bessissow, FRCP (C), FRCPC, MD, MSc, Associate Professor, Doctor, Postdoctoral Fellow, Staff Physician, Division of Gastroenterology, McGill University Health Center,1650 Avenue Cedar C7-200, Montreal, QC H3G 1A4, Canada.
Telephone: +1-514-9341934 Fax: +1-514-9348531
Received: April 19, 2019
Peer-review started: April 19, 2019
First decision: June 10, 2019
Revised: June 27, 2019
Accepted: July 2, 2019
Article in press: July 3, 2019
Published online: August 14, 2019

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.

Keywords: Inflammatory bowel disease, Elderly, Outcomes, Glucocorticoids, Biological therapy, Surgery

Core tip: Two types of inflammatory bowel disease (IBD) exist in the elderly (patients aged 60 or over): adult-onset vs elderly-onset. Disease phenotypes, outcomes and drug regimens may change based on the type of IBD. Recently, population-based trials have suggested increased corticosteroid use and decreased utilization of biologic agents in the elderly IBD population compared to their younger counterparts, likely owing to the perceived high rates of infections and malignancy from anti-tumor necrosis factor (TNF) agents. This article reviews the current available literature on the management of inflammatory bowel disease in the elderly patients, including anti-TNF agents, anti-integrin molecules, anti-interleukin 12/23 agents and IBD-related surgeries.