Search

Summary: Background: Thiopurines are the most widely used immunosuppressants in IBD although drug‐related adverse events (AE) occur in 20%‐30% of cases. Aim: To evaluate the safety of thiopurines in elderly IBD patients Methods: Cohort study including all adult patients in the ENEIDA registry who received thiopurines. Patients were grouped in terms of age at the beginning of thiopurine treatment, specifically in those who started thiopurines over 60 years or between 18 and 50 years of age. Thiopurine‐related AEs registered in the ENEIDA database were compared. Results: Out of 48 752 patients, 1888 started thiopurines when over 60 years of age and 15 477 under 50 years of age. Median treatment duration was significantly shorter for those who started thiopurines >60 years (13 [IQR 2‐55] vs 32 [IQR 5‐82] months; P < .001). Patients starting >60 years had higher rates of all types of myelotoxicity, digestive intolerance and hepatotoxicity. Thiopurines were discontinued due to AEs (excluding malignancies and infections) in more patients starting >60 years (67.2% vs 63.1%; P < .001). Elderly age and female sex were independent risk factors for most AEs. Conclusion: In elderly IBD patients, thiopurines are associated with an increased risk of non‐infectious, non‐neoplastic, AEs. [ABSTRACT FROM AUTHOR]

Summary: Background: Cohort studies comparing the characteristics of childhood‐onset and adulthood‐onset inflammatory bowel disease (IBD) in the biologics era are scarce. Aim: To compare disease characteristics, the use of immunomodulators and biologic agents and the need for surgery between childhood‐ and adulthood‐onset IBD. Methods: Inflammatory bowel disease patients from the ENEIDA registry diagnosed between 2007 and 2017 were included. The childhood‐onset cohort comprised patients diagnosed at ≤16 years of age and the adulthood‐onset cohort those diagnosed at >16 years. The cumulative incidences of immunosuppressive therapy, biologic therapy and surgery were estimated using Kaplan‐Meier curves, compared by the log‐rank test. Cox regression analysis was performed to identify potential predictive factors of treatment with immunosuppressants, biologic agents or surgery. Results: The adulthood‐onset cohort comprised 21 200 patients out of 20 354 (96%) and the childhood‐onset cohort 846 (4%). Median follow‐up was 54 months in the childhood‐onset cohort and 38 months in the adulthood‐onset cohort (P < 0.01). Proportions of Crohn's disease, ileocolonic involvement and inflammatory behaviour at diagnosis were higher in the childhood‐onset cohort. In the multivariate analysis, after adjusting for sex, type of IBD, extraintestinal manifestations, family history and smoking habit, childhood‐onset IBD was associated with higher risk of immunomodulator use (hazard ratio [HR] = 1.2, 95% confidence interval [95% CI] = 1.1‐1.2) and higher probability of receiving biologic treatment (HR = 1.2, 95% CI = 1.1‐1.3). However, childhood‐onset IBD was not associated with higher risk of surgery (HR = 0.9, 95% CI = 0.8‐1.2). Conclusions: Childhood‐onset IBD has differential characteristics and higher risk of treatment with immunomodulators and biologic agents, compared with adulthood‐onset IBD. Nevertheless, paediatric IBD is not associated with higher risk of surgery. [ABSTRACT FROM AUTHOR]