Late-Onset IBD Shows Distinct Disease Patterns and Different Biologic Utilization
Patients diagnosed with inflammatory bowel disease (IBD) at age 60 years or older exhibit distinct disease phenotypes and treatment patterns compared with younger patients, according to a large multicenter analysis of more than 32,000 individuals enrolled in the NIHR IBD BioResource.
Investigators evaluated patients with late-onset (LO) ulcerative colitis (UC) and Crohn’s disease (CD), defined as diagnosis at age 60 years or older, and compared them with patients diagnosed at younger ages. The study included 32,012 patients overall, comprising 16,930 with UC and 15,082 with CD.
Distinct differences in disease presentation emerged. Among patients with UC, LO disease was more commonly left-sided and less likely to present as isolated proctitis. In CD, patients with LO disease had lower rates of ileocolonic involvement and perianal disease than younger cohorts.
Treatment patterns also differed substantially. Patients with LO-UC and LO-CD were less likely to receive corticosteroids, immunomodulators, or anti–tumor necrosis factor alpha (anti-TNF) therapies. Despite lower exposure to these therapies, clinical outcomes appeared comparable with those of younger patients. Investigators found “no difference in time to colectomy” among patients with UC and no difference in time to intestinal resection among patients with CD.
Biologic selection differed as well. Patients with LO-CD were more likely to receive vedolizumab and ustekinumab than patients with young-onset CD. The findings suggest that factors beyond disease activity may influence therapeutic decisions in older adults.
Management differences were particularly evident in perianal CD. Patients with LO disease and perianal involvement were less likely to receive anti-TNF therapy or undergo perianal surgery than younger patients with similar disease manifestations.
According to the authors, “LO-IBD has a distinct phenotype,” characterized by less isolated proctitis in UC and less ileocolonic and perianal disease in CD. They further noted that “LO-CD is notable for the higher use of vedolizumab and ustekinumab,” suggesting that age, comorbidity burden, and disease phenotype may influence biologic selection.
Reference
Peter F G Foulser, Laura Martinez-Gili, Sharmili Balarajah, et al. Disease phenotype affects treatment of late-onset inflammatory bowel disease: Analysis of a large UK cohort. Inflammatory Bowel Diseases. 2026;, izag072. https://doi.org/10.1093/ibd/izag072
