Bharati Kochar, MD, on Managing IBD in Older Adults

Dr Kochar discusses the particular concerns of older patients with inflammatory bowel disease, how this population is growing, and what research is showing regarding the best options for treatment.

Bharati Kochar, MD, is a gastroenterologist and IBD specialist with Massachusetts General Hospital in Boston, Massachusetts.

TRANSCRIPT

Hello, my name is Bharati Kochar. I'm a gastroenterologist and IBD specialist at the Mass General Hospital in Boston. I'm very excited to speak to you about the management of older adults with IBD.

As you know, IBD has a bimodal peak of incidence with a second peak in the sixth and seventh decades of life, and the American population is rapidly aging. The combination of increasing IBD incidence, improved disease and treatment-related knowledge, and decreasing IBD fatality, as well as the aging population, is resulting in a high prevalence of older adults with IBD.

One 2015 estimate by the Centers for Disease Control, CDC, reported that 26% of Americans living with IBD are 65 years or older. However, older adults with IBD are not adequately represented in clinical trials. A review our group conducted that's currently in press with the Inflammatory Bowel Diseases journal found that less than 1% of adults in clinical trials of approved IBD therapies are 65 years and older.

Most IBD trials do not publish subgroup analyses of efficacy and safety in older adults or report other aging-related constructs. Therefore, we don't know how well many of these medications work and how safe they are, specifically for older adults.

To start answering some of these questions, we conducted a comparative effectiveness and safety study of biologic agents in the 50 state Medicare claims database that we recently presented at the 2021 Crohn's & Colitis Congress.

In this study, we used advanced pharmacoepidemiologic strategies to minimize the bias that is inherent in these retrospective studies.

In our study, we found 480 adults who are 65 years and older who newly started vedolizumab, or Entyvio, and about a little over 1,100 older adults who newly started an anti-TNF agent between 2014, which is when vedolizumab was first approved, and 2017, the point of latest data availability in this database.

With a median age of 71 years, and 11% of the cohort being 80 years or older, this is one of the oldest cohorts in studies of IBD medications.

In this study, we found no significant difference between anti-TNF agents and vedolizumab in our efficacy outcomes, which were IBD-related hospitalizations, IBD-related surgery, and new steroid use after the completion of induction therapy.

We found that older adults treated with vedolizumab had half the risk of an infection-related hospitalization even after including weighted variables and adjusting for clinically pertinent covariates. We're submitting a manuscript with these data soon. We hope that the numbers in our manuscript will be helpful to counsel older patients starting biologic agents.

In general, it's very important to recognize that older adults are presenting with moderate to severe disease that requires biologic therapy. Treatment plans should be tailored to the patient and their disease. Certainly we need additional large comparative effectiveness and safety studies, as the arsenal of medications to treat IBD is rapidly proliferating.

I hope what I can do is draw attention to the fact that we need more focus studies on the rapidly aging population of older adults with IBD. Thank you very much for your time.