771 No Increase in Odds for Infection or Malignancy When Treating to Disease Severity in Elderly IBD Patients

Abstract

INTRODUCTION: The prevalence of inflammatory bowel disease (IBD) in the elderly population is increasing. Current studies suggest that the use of immunosuppressive therapies in this population leads to a higher risk of complications, particularly an increase in infections. However, many studies show prolonged steroid use and ongoing active inflammation in elderly patients, suggesting undertreatment of their IBD. The aims of this study were to assess for an increase in infections or malignancy among an elderly Veteran population of IBD patients with treatment based on disease severity and disease activity. METHODS: After obtaining IRB approval, we performed a retrospective chart review of all VA IBD patients seen in the outpatient Gastroenterology Clinics at the Hunter Holmes McGuire VA Medical Center from January 1, 1999 through March 27, 2019. Data collected included demographic data, details of the IBD history, medication use, and any history of infection or malignancy after IBD diagnosis. Breslow-Day test was used to determine the Odds Ratios between elderly (diagnosed at 60 years or older) and non-elderly cohorts for each outcome based on medication use. RESULTS: 153 Veterans with IBD were included: 126 (82.4%) male, 80 (52.3%) had UC, and 132 (86.3%) diagnosed <60 years of age (Table 1). At enrollment, most non-elderly subjects were treated with 5-ASAs (49%) then biologics (44%) compared to 62% of elderly subjects on 5-ASA and 38% on biologics. At one year of follow-up, there was no difference in the odds of developing infection or malignancy for elderly compared to non-elderly IBD patients with any IBD therapy (Table 2). CONCLUSION: In this single-center retrospective study, we found no increase in infections or malignancy in elderly IBD patients regardless of IBD therapy. Our elderly cohort is small, so our study may have been underpowered, however data collection is ongoing.