While there may be some reluctance to prescribe combined immunosuppression in older people with Crohn’s disease because of a perceived risk of treatment-related complications, a new research suggests that early combined immunosuppression may actually be safe and effective in this population.
Researchers undertook a post hoc analysis of the randomised evaluation of an algorithm for Crohn's treatment (REACT) trial, which compared combined immunosuppression versus conventional management in 1,981 patients with Crohn's disease.
Over 24 months, 10 per cent of older patients developed Crohn's disease‐related complications (6.4 per cent of those in the combined immunosuppression group versus 14.5 per cent of those in the conventional management group). There was no difference between younger and older patients in risk of achieving corticosteroid‐free clinical remission or time to major adverse outcome.
“It is important to treat aggressive Crohn's disease appropriately regardless of age,” said lead author Dr Siddharth Singh of the University of California San Diego. “This may include early step-up combination therapy of tumour necrosis factor (TNF)-alpha antagonists with thiopurines, which is effective and safe even in older patients, rather than treating these patients with chronic or repeated courses of corticosteroids.”
The research is published in Alimentary Pharmacology & Therapeutics.