Biologic Therapy in Elderly Patients with IBD: Current Trends and Special Management Considerations

Abstract

With the aging IBD population and increasing incidence of elderly-onset IBD, the overall prevalence of IBD in the elderly is rising. The elderly have unique medical, psychosocial, and other age-related comorbidities and disabilities that need to be taken into account when assessing the impact of IBD on the patient’s overall health and quality of life, and choosing an effective therapy. There is a general reluctance among physicians to prescribe biologic therapies out of concerns of their potential side effects, in favor of mesalamine, steroids, and surgery. Although there is an overall paucity of robust data on biologic use in the elderly from randomized clinical trials, recent retrospective and real-world studies provide insight on the safety and efficacy of anti-TNF and other biologics in this population. This review analyzes and highlights the most recent data on biologic therapies in the elderly, so physicians can make informed decisions and judiciously use biologics in the elderly with moderate to severe IBD, keeping in mind the goals of care in this population, i.e., effectively and safely control IBD symptoms, minimize steroid use, prevent short-term disease complications and hospitalization, restore the patient’s quality of life and functionality, and prevent further frailty and disability.