title: Biologic agent use varies inversely with age at diagnosis in Crohn's disease.
abstract: BACKGROUND
  For patients with Crohn's disease, age at onset is known to influence the clinical course of the illness.
  
  
  OBJECTIVE
  The aim of this study is to seek an association between age at onset of Crohn's disease and use of biologic agents for its treatment.
  
  
  METHODS
  We reviewed the medical records of 127 veteran patients with Crohn's disease treated at our hospital, and compared differences in age at disease onset between patients who had received biologics and those who had not.
  
  
  RESULTS
  The mean age of our patients was 54.9 ± 15.4 years, and 34% were currently receiving or had previously received treatment with a biologic agent. For those with biologic use, average age at time of diagnosis of Crohn's disease was 32.3 ± 12.2 years, compared with 43.7 ± 16.3 years for those who had not received biologics (P = 0.005). This relationship remained significant even after controlling for disease severity. The frequency of use of biologic agents varied inversely with age at diagnosis. For patients diagnosed before age 21 years, 55.5% had used biologics, whereas no patient >70 years of age at time of diagnosis had used biologics. We found no significant correlation between biologic use and duration of disease, smoking or ethnicity. Perianal disease and concomitant arthritis were both significantly associated with use of biologics.
  
  
  CONCLUSIONS
  In our veteran patients with Crohn's disease, frequency of treatment with a biologic agent varied inversely with age at disease onset.
authors.affiliation: Division of Gastroenterology, VA North Texas Health Care System and the University of Texas Southwestern Medical Center at Dallas, Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216, USA. LindaA.Feagins@va.gov
authors.forename: Linda A
authors.initials: LA
authors.lastname: Feagins
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Spechler
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001168:Arthritis / Q000453:epidemiology; D002464:Cell Migration Inhibition; D000068582:Certolizumab Pegol; D003424:Crohn Disease / Q000188:drug therapy* / Q000453:epidemiology*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D000069442:Natalizumab; D011092:Polyethylene Glycols / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007140:Immunoglobulin Fab Fragments; D007155:Immunologic Factors; D000069442:Natalizumab; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol