Elderly-Onset Inflammatory Bowel Disease Has Distinct Disease Characteristics and Treatment Patterns

Background and Aims: Elderly-onset inflammatory bowel disease (IBD) patients (age ≥ 60 at diagnosis) have unique characteristics that require special consideration. Using a real-life registry-based cohort, we compared disease phenotypes and treatment exposures between adult-onset (18 ≤ age < 60 years) and elderly-onset IBD patients. Methods: Demographics, disease characteristics, and treatment were compared between adult- and elderly-onset IBD patients diagnosed during 2000–2022 with ≥ 12 months follow-up. Results: Of 3307 adult IBD patients, 290 (9%) were elderly-onset. This group exhibited a higher prevalence of colon-only involvement, with higher rates of ulcerative colitis (UC, 38.3% vs. 31.4%, p = 0.02) and more colonic L2 Crohn's Disease (CD, 21% vs. 12%, p < 0.001) then adult-onset group. Elderly-onset CD also showed less ileocolonic L3 disease (14% vs. 29%, p < 0.001), less penetrating B3 phenotype (7.4% vs. 19%, p < 0.001), and less perianal involvement (10% vs. 20%, p < 0.001). Elderly-onset CD and UC patients received more 5-ASA (36% vs. 17%, p < 0.001 in CD and 75% vs. 63%, p = 0.02 in UC). In contrast, these patients were exposed to considerably less biologics and/or JAK inhibitors (37% vs. 56% for CD and 20% vs. 35% for UC, p < 0.001), with higher 15-year biologic-free survival among elderly-onset IBD. First-line biological choices also substantially differed, with adult-onset receiving more anti-TNFs and elderly-onset receiving more Vedolizumab. We did not observe higher rates of IBD-related surgeries and steroid use between the groups. Conclusions: Elderly-onset IBD shows higher prevalences of colon-only IBD (UC and L2 CD). Treatment strategies in elderly-onset IBD favor 5-ASA and show reduced biological use, with preferences for Vedolizumab over anti-TNFs.