title: Medication Utilization and the Impact of Continued Corticosteroid Use on Patient-reported Outcomes in Older Patients with Inflammatory Bowel Disease.
abstract: Older individuals with inflammatory bowel disease (IBD) require ongoing medications. We aimed to describe (1) medication use in older and younger IBD patients and (2) medication associations with patient reported outcomes (PROs) in older patients.
  
  
  
  We conducted cross-sectional and longitudinal analyses within CCFA Partners internet-based cohort of patients with self-reported IBD. We assessed medication use by disease sub-type and age. We used bivariate analyses to (1) compare medication use in older and younger patients and (2) determine associations between continued steroid use and patient reported outcomes in older patients.
  
  
  
  We included 5382 participants with IBD; 1004 were older (≥age 60). Older patients with Crohn's disease (CD) had lower antitumor necrosis factor alpha (anti-TNF) use at baseline (29.1% versus 44.3%, P < 0.001), comparable steroid use (16.0% versus 16.5%, P = 0.77), and higher aminosalicylate use (40.3% versus 33.9%, P = 0.003) versus younger patients. Older ulcerative colitis (UC) patients had similar anti-TNF use (16.0% versus 19.2%, P = 0.16), lower steroid use (9.6% versus 15.4%, P = 0.004), and higher aminosalicylate use (73.8% versus 68.2%, P = 0.04) at baseline. In longitudinal analyses, older CD patients had higher continued steroid use (11.6% versus 7.8%, P = 0.002); which was associated with worsened anxiety (P = 0.02), sleep (P = 0.01), and fatigue (P = 0.001) versus nonuse. Older CD patients on steroids, versus anti-TNF or immunomodulators, had increased depression (P = 0.04) and anxiety (P = 0.03).
  
  
  
  Medication utilization differs in older patients with IBD. Older CD patients have higher continued steroid use associated with worsened patient reported outcomes. As in younger IBD populations, continued steroid use should be limited in older patients.
authors.affiliation: *University of North Carolina at Chapel Hill School of Medicine; †Department of Medicine, Division of Gastroenterology and Hepatology, University of California, Los Angeles, California; ‡Center for Gastrointestinal Biology and Disease, Chapel Hill, North Carolina; §Department of Pediatrics, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ‖Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and ¶Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Matthew
authors.initials: M
authors.lastname: Geisz
authors.forename: Christina
authors.initials: C
authors.lastname: Ha
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Martin
authors.forename: Wenli
authors.initials: W
authors.lastname: Chen
authors.forename: Kristen
authors.initials: K
authors.lastname: Anton
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.forename: Millie D
authors.initials: MD
authors.lastname: Long
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001007:Anxiety / Q000139:chemically induced; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D003863:Depression / Q000139:chemically induced; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D012893:Sleep Wake Disorders / Q000139:chemically induced; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D019804:Mesalamine