Polypharmacy prevalent in older adults with IBD

Polypharmacy appears common and tends to increase with age in patients with inflammatory bowel disease (IBD), reveals a study.

The year-by-year level of polypharmacy is stable across age groups, with no signs of a decreasing trend in older adults with IBD.

“For older persons with IBD, polypharmacy is a pivotal concern along with physical and psychological morbidity and locomotor function, which underpins the need for personalized special care,” the investigators said. “It must be emphasized that the message is not to undertreat IBD.”

A total of 21,255 young adults, 13,432 adults, 8,271 older adults, and 933 oldest adults were included in this study. [Br J Clin Pharmacol 2025;91:3121-3129]

The prevalence of moderate polypharmacy at 1 year after IBD diagnosis was 15.1 percent for young adults, 23.2 percent for adults, 38.1 percent for older adults, and 49.4 percent for oldest adults. For excessive polypharmacy, the proportions were 1.5 percent, 5.4 percent, 16.6 percent, and 23.4 percent, respectively.

Among patients aged ≥60 years, the adjusted odds ratio for polypharmacy in 2020 vs 1997 was 1.02 (95 percent confidence interval, 0.71–1.47).

“When estimating the risk of polypharmacy (≥5 prescriptions) in patients aged ≥60 years in 2018–2020, relative to 1997–1999, we found no signs of a decreasing risk of polypharmacy,” the investigators said.

Complex patterns

The development of new medications for various conditions and their usage (eg, the introduction of new types of biologics for the IBD population) adds to the complexity of polypharmacy, according to the investigators, who noted complex patterns related to IBD in older patients and the use of medications.

"We, and others, have previously shown that older adults have a lower chance of initiation of IBD medication compared to adults, and older adults were less often treated with biologics,” they added. [Aliment Pharmacol Ther 2023;58:48-59; Gastroenterology 2018;154:518-528]

Furthermore, the proportions of patients with redeemed prescriptions for several groups of non-IBD medication across all groups were significantly higher following an IBD diagnosis. [Inflamm Bowel Dis 2023;30:1965-1973]

“In the general population, the increased use of all types of medications, by increasing age, was shown in a Danish drug utilization study where 89 percent of all older adults (≥60 years) filled 1 prescription and with a median number of unique medication classes of 5 per person,” the investigators said. [Eur J Clin Pharmacol 2019;75:1125-1133]

Method

The present study included a nationwide cohort of adult incident IBD patients from 1 April 1996 to 31 December 2019. The investigators analysed medication prescriptions across calendar years among young adults (18–39 years), adults (40–59 years), older adults (60–79 years), and oldest adults (≥80 years).

Prescriptions were classified as follows: 0, 1–4, 5–9 (moderate polypharmacy), and ≥10 (excessive polypharmacy). These were described 1 year prior to IBD diagnosis and 1, 2, and 3 years post-IBD diagnosis. The risk of polypharmacy (moderate and excessive) 1 year after diagnosis was estimated in older patients using regression models, with comparisons between recent and early years.