In a recent study issued in European Journal of Gastroenterology & Hepatology, Vedolizumab was found to be an ideal first-line treatment option in elderly patients with inflammatory bowel diseases (IBD) along with steroid-dependent moderate-to-severe ulcerative colitis. Also, the medicine choice is based on older age and comorbidity (main predictor of colectomy). In different countries, the geographical heterogeneity in suggesting habits may associate to medication reimbursement.

This study based on an international case-based survey, evaluated the gastroenterologists’ preference in the medicine prescription or surgery in geriatric patients with IBD, and the associated factors.

Three cases of steroid-dependent ulcerative colitis evaluating young versus old-age patients, with and without comorbidity were portrayed. The physician characteristics and demographics were assembled. The logistic regression analysis was used to determine the factors concerning selection of different drug/therapies choices.

The survey inculcated 424 respondents from 41 countries. The most preferred treatment choices for moderate-to-severe ulcerative colitis were- Vedolizumab (53.2%) and thiopurines (19.4%) in different case scenarios, shown below:

Table: Treatment choices as per cases 

The comorbidity and older age were independently linked commonly with frequent use of vedolizumab, and less frequently with anti-tumour necrosis factor (TNF) and immunomodulators. The only independent predictor for selecting colectomy was comorbidity. Lymphoma history (94%) and opportunistic infection (78.3%) were the most frequent conditions preventing thiopurine and anti-TNF use in old age patients.

Only 6.1% of respondents considered patient age as a constraint for vedolizumab, whereas 37.9% considered age as a limiting factor in thiopurines prescription. Considering geographical heterogeneity, more doctors from Oceania and North America favored vedolizumab use.