P0353 Impact of Aging, Immunosenescence and Inflammaging on the Clinical Phenotype of Inflammatory Bowel Disease: Data from the Brazilian National IBD Registry (GEDIIB)

Abstract Background Aging modifies immune responses through immunosenescence and inflammaging, mechanisms that may alter the presentation, complications and treatment patterns of inflammatory bowel disease (IBD). This study aimed to evaluate clinical and therapeutic differences between elderly (≥ 65 years) and non-elderly (< 65 years) patients enrolled in the Cadastro Nacional de Pacientes com Doença Inflamatória Intestinal – GEDIIB (Brazilian National IBD Registry). Methods A cross-sectional analysis included 4,419 patients with inflammatory bowel disease (IBD) from the GEDIIB Registry. Patients were stratified by age group (elderly ≥ 65 years vs non-elderly < 65 years). Demographic data, diagnosis (ulcerative colitis vs Crohn’s disease), initial manifestations, extraintestinal features, fistulising behaviour (in Crohn’s disease only), comorbidities, complications and treatment classes were analysed. Comparisons between groups were performed using Student’s t-test for continuous variables and χ² or Fisher’s exact test for categorical variables. A p-value of < 0.05 was considered statistically significant. Results Of 4,419 IBD patients, 196 (4.4 %) were ≥ 65 years. Compared to non-elderly patients, elderly individuals showed: • A lower proportion of Crohn’s disease (43.4 % vs 54.6 %, p = 0.013); • Among Crohn’s disease patients, fewer fistulas (9.8 % vs 26.1 %, p < 0.001); • Reduced extra-intestinal manifestations (rheumatologic 10.7 % vs 20.1 %, p = 0.001); • Increased comorbidities, notably hypertension (56.1 % vs 16.2 %) and diabetes (23.0 % vs 6.4 %) (p < 0.001); • Lower use of immunosuppressants (10.9 % vs 22.8 %, p < 0.001) and higher use of salicylates (45.1 % vs 31.5 %, p < 0.001); • Among biologics, a higher frequency of vedolizumab (20.5 % vs 12.9 %) and ustekinumab (17.0 % vs 7.8 %) in elderly patients (p < 0.05). Conclusion Elderly patients with IBD exhibited a milder Crohn’s disease phenotype, with less fistulising and extra-intestinal involvement, yet a higher burden of systemic comorbidities. These findings are consistent with immune-remodelling through immunosenescence and inflammaging, which attenuate adaptive inflammatory responses while enhancing chronic systemic inflammation.Elevated and deregulated cytokines such as IL-6 and IL-10, previously linked to disease severity and comorbidity in inflammatory conditions, may also contribute to the altered immune environment in older IBD patients and leading to a different presentation of IBD in this group. Recognition of these mechanisms is essential for individualized therapeutic strategies and improved outcomes in the ageing IBD population. References: 1. Ha CY et al. Clinical characteristics of inflammatory bowel disease in older adults: a multicenter study. Clin Gastroenterol Hepatol. 2010;8(11):1005–1012. 2. Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci. 2014;69(Suppl 1):S4–S9. 3. Moura FA et al. Impact of aging on inflammatory bowel disease: immunosenescence, inflammaging and clinical implications. World J Gastroenterol. 2021;27(13):1171–1189. PMCID: PMC79977044. 4. Simon AK et al. Evolution of the immune system in humans from infancy to old age. Nat Rev Immunol. 2015;15(5):279–293. 5. Luporini RL. IL-6 and IL-10 are associated with disease severity and higher comorbidity in adults with COVID-19. Conflict of interest: Luporini, Rafael: Personal fees: received honoraria as speaker from Takeda, AbbVie, and Johnson & Johnson. Non-financial support: received congress expenses coverage. Prof. Dr. Parra, Rogerio: No conflict of interest Parente, Jose Miguel: Speaker of Johnson & Johnson, Takeda, Abbvie Felipe Alves De Sousa, Gabryel: No Conflict of Interest Amorim, Gabriel Stumpf Bastos: No conflict of interest Yukie Sassaki, Ligia: No conflict of interest Hossne, Rogério: Speaker: J & J, Abbive, Takeda, Pfizer. Advisory Board: J & J, Abbive, Takeda, Pfizer Baima, Júlio: Financial Support/Relationship: Speaker honoraria, congress support, and consulting: Johnson & Johnson, AbbVie, Takeda and Ferring. Research Funding: Clinical research investigator from AstraZeneca. Froes, Renata: Speaker: J & J, Takeda, Abbvie, Pfizer, Ferring, Sanofi, Celltrion, Nestle, GSK, CSL Vifor. Advisory board: J & J, Takeda, Abbvie, Pfizer. Barreto, Karen: No conflict of interest Rios Do Nascimento, Catiane: Não tenho conflito de interesse Kaiser Junior, Roberto Luiz: No conflict of interest Faria, Mikaell Alexandre Gouvea: No conflict of interest Joudatt, Juliano: No conflict of interest Zabot Pandolfo, Gilmara: None Cunha, Ricardo Valli da: None Zaltman, Cyrla: Received fee as speaker or as an advisory board member for Abbvie, Takeda, Pfizer, Johnson & Johnson, and received research funding from Johnson & Johnson, Takeda, Lilly, Pfizer Felgueiras, Carolina Costa: No conflict of interest Coelho Demetrio, Wanda: None Fontes, Jaciane Araujo Mota: No conflict of interest Andrade, Vitor Torres: No conflict of interest Marques dos Santos, Carlos Henrique: none Carvalho, Bernardo: Conference sponsorship Ferreira, Silvia: No conflict of interest De Souza Menegassi, Vivian: no conflict of interest Fonseca, Tamyla Alves: No conflict of interest Dassoler, Rafaela: No conflicts of interest Oliveira Santana Silva, Genoile: Honoraria - Abbvie, Johnson & Johnson, Ferring, Takeda. Research - Abivax, Takeda, Johnson & Johnson, Roche, Sanofi, Polpharma. Advisory board - Abbvie, Johnson & Johnson, MSD. Lopes, Ana Carolina Benvindo: No conflict of interest Trajano Vasconcelos, Heveline: No conflict of interest Bafutto, Mauro: NONE Loures, Marcela: Abbvie Takeda J & J Flores, Cristina: Personal Fees: Advisory boards Abbvie, Pfizer, J & J, Takeda, MSD, Amgen Speaker Abbvie, Takeda, J & J, Amgen. Clinical reserach: Abbvie, MSD, J & J. Quaresma, Abel: Speaker Jansen and Celltrion Andrade, Lais: Received speaker fees from Johnson & Johnson and travel/congress support from Johnson & Johnson, Takeda, and AbbVie. Silva, Amanda: None Borges, Valéria Ferreira De Almeida E: There are no conflicts of interest to declare. Cassol, Ornella: No conflict of interest de Lima Jr., Sérgio: there is not Vilela, Eduardo: None