For Patients with Crohnʼs Disease, Biologic Agent Use Varies Inversely with Age at the Time of Diagnosis

Abstract

Purpose: We have noted that patients with Crohn's disease treated in our VA hospital generally are older than those seen in community hospitals. The aim of this study was to evaluate how the use of biologics varies with age and disease duration in our patients. Methods: We reviewed the medical records of 112 veteran patients with Crohn's disease who have been treated at our hospital, and compared differences in age and a number of other demographic features between patients who have received biologics and those who have not. Results: The average age of our patients is 54.9 years (range 24-87), and 32% are currently receiving or have previously received treatment with a biologic agent (infliximab or adalimumab). For the patients who have received biologics, the average age at the time of diagnosis of Crohn's disease was 33.8 years, compared to 43.4 years for the patients who had not received biologics (p=0.002). The frequency of using biologic agents varied inversely with the age at diagnosis (see figure). For patients whose Crohn's disease was diagnosed before age 21, 66.7% have used biologics, whereas no patient >71 years of age at the time of diagnosis has used biologics. We found no significant correlation between biologic use and duration of disease (17.6 years for biologic users vs. 13.7 years for non-users, p=0.12 ), smoking status (non-smokers comprised 36% of the biologic users vs. 26% of the non-users, p=0.37 ), ethnicity (whites comprised 80.6% of the biologic users vs. 77.6% of the non-users, p=0.81) and presence of perianal disease (22.2% in biologic users vs. 9.6% in non-users, p=0.08).Table 1: EtOH and smoking statusConclusion: At the time of diagnosis of Crohn's disease, our patients who have been treated with biologics were almost 10 years younger than those who have not received biologics. Furthermore, the frequency of using biologic agents varies inversely with age at the time of diagnosis. It is not clear whether this reflects a difference in disease severity or response to other medications in patients who develop Crohn's disease at an earlier age, or a reluctance on the part of physicians to prescribe biologic therapy for patients who develop Crohn's disease later in life.Figure