P140 Physician attitudes about the use of immunosuppressive therapy for inflammatory bowel disease in the elderly. (16th January 2018)

• Record Type: Journal Article
• Authors: Chan, W P W; Kim, S; Ding, J N; Kariyawasam, V; Leong, R W
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S165
• Page End: S167
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.267
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: The prevalence inflammatory bowel disease (IBD) in the elderly (arbitrarily defined as age >60 years) is rapidly rising. Whether patients' age or presence of comorbidity affect gastroenterologists' prescribing habit for immunosuppressive therapy is unknown. Perceived safety or availability of certain biological agents within certain countries might be predictive factors. Methods: We conducted a scenario-based questionnaire in Australia (enforced trial of azathioprine needed, but no limitation in option for biological agent prescribing order) and Europe (azathioprine not enforced, anti-TNF preferred over vedolizumab). three scenarios were tested: High Age/No Comorbidity (HANC) (76-year-old female with steroid dependent active extensive ulcerative colitis); High Age/High Comorbidity (HAHC) (same patient but with diabetes mellitus and nephropathy and breast cancer in remission); and Low Age/High Comorbidity (LAHC) (28-year-old female with same comorbidity as HAHC) Results: In total 227 surveys were returned for analysis (35% Europe, 57% Australia). There were 130(58%) gastroenterologists with a mean 12.3 years of IBD experience; and 72(31.4%) gastroenterology fellows/registrars. In the combined cohort, azathioprine was the first choice for subjects of HANC and LAHC, and vedolizumab for HAHC patients (Figure 1). Anti-TNF was the first choice in Europe and azathioprine in Australia for HANC ( p < 0.0001). Vedolizumab was the first choice for both groups of doctors for HAHC ( p = 0.60). Vedolizumab was the first choice in Europe ( p = 0.60)and azathioprine the first choice in Australia for LAHC ( p = 0.46) (Figure 2a–c, Table 2). Age and comorbidities (HAHC vs. LAHC, and HANC vs. HAHC respectively) affected the decision to prescribe azathioprine, anti-TNF, vedolizumab, and surgery (all p < 0.05), but not for prednisolone ( p = 0.23) (Table 1). Over 60% of respondents did not commence immunosuppressive therapies in the elderly if they had prior lymphoma/cancer, hepatotoxicity, and opportunistic infections. Over 70% of the respondents suggested that none of the above-mentioned conditions influenced their decision to prescribe vedolizumab (Figure 3) Conclusions: Age and comorbidity are independent factors in the choice of immunosuppressive therapies. Azathioprine is the preferred option for high-age or high-comorbidity but vedolizumab becomes first choice for combined high-age and high comorbidity. Vedolizumab is preferred for prior cancers and comorbidity. Prescription pattern differs between Europe and Australia, most likely due to local regulatory authorisation variations.