Polypharmacy Is Common in Crohn's Disease

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The chronic, multifactorial nature of Crohn's disease—an inflammatory condition characterized by periods of active disease and remission—often is associated with polypharmacy. Agents used to treat Crohn's disease include aminosalicylates, steroids, azathioprine, mercaptopurine, methotrexate, and infliximab, all of which are associated with potentially serious adverse effects. Patients with Crohn's disease may have comorbid conditions for which they take prescription or OTC medications, vitamins, and supplements. The results of a 5-year retrospective evaluation of polypharmacy in 291 patients with Crohn's disease were reported recently in Alimentary Pharmacology and Therapeutics.

R. K. Cross, MD, and colleagues identified minor polypharmacy (2-4 medications) in 37% to 40% of the patients and major polypharmacy (≥5 medications) in 50% to 57% of the patients. A direct correlation was demonstrated between major polypharmacy and women older than 40 with disease exceeding 10 years. Polypharmacy was associated with greater disease severity and lower quality-of-life scores, suggesting adverse drug reactions and deleterious drug-drug interactions. Approximately 10% of patients experienced symptom improvement on medication withdrawal, particularly of nonsteroidal anti-inflammatory drugs and aminosalicylates. The authors concluded that, whenever possible, the use of multiple drug therapy for patients with Crohn's disease should be minimized and that nonessential medications should be discontinued.