P471 Clinical characteristics and complications in hospitalised elderly patients with ulcerative colitis in a real-world specialised hospital

Abstract

Background: There are special concerns, including safety, that need to be addressed when devising treatment strategies for ulcerative colitis (UC) in elderly patients. Given the increasing number of elderly patients with UC in Japan, we aimed to investigate the efficacy of several treatments and the issues including complications in elderly patients with UC as real-world data. Method(s): In this single-centre retrospective case-control study, we investigated 220 hospitalised patients with UC from January 2013 to December 2015 at our hospital. The patients were divided into two groups: an elderly group aged >=60 years (n = 42) and a nonelderly group aged <60 years (n = 178). The clinical background, treatment efficacy, treatment safety, and issues were compared between the two groups. Result(s): The proportions of left-sided colitis and complicated cytomegalovirus infection at admission were significantly higher in the elderly group (35.7%, 65.7%) than in the non-elderly group (19.7%, 25.8%) (P = 0.03, p < 0.001). The maximal dose of steroid per day within a month before admission was significantly lower in the elderly group (14.5 +/- 18.0 mg) than in the non-elderly group (50.8 +/- 146.8 mg) (p = 0.006). There was a significant difference in the contents of first-line remission induction therapy between the two groups (p = 0.02) (steroid 35.7%, tacrolimus 23.8%, cytapheresis 11.9%, infliximab 11.9%, adalimumab 2.4% in the elderly group; 38.8%, 37.1%, 2.8%, 14.6%, and 0% in the non-elderly group, respectively). There was no difference in remission induction or the response rate to these treatments, as well as in the surgical rate between the two groups (p = 0.13). However, the response rate to steroid treatment tended to be lower in the elderly (40.5%) than in the non-elderly (64.0%) (p = 0.03). The complications of cytomegalovirus infection and catheter infection were significantly higher in the elderly group (66.7%, 11.9%) than in the non-elderly group (25.8%, 2.8%) (p < 0.001, p = 0.03). No case achieved remission through second-line therapy after the failure of first-line treatment in the elderly group. Conclusion(s): The efficacy of first-line therapy in the elderly group was not inferior to that in the non-elderly group, although the elderly group had more infection-related complications. However, the efficacy of steroid as a first-line therapy or overall second-line therapy was inferior in the elderly group. In case of failure of the first-line therapy, surgery should be considered as a life-saving measure.