Polypharmacy Is Common in Crohn's Disease

The chronic, multifactorial nature of Crohn'sdisease—an inflammatory condition characterizedby periods of active disease and remission—often is associated with polypharmacy. Agentsused to treat Crohn's disease include aminosalicylates,steroids, azathioprine, mercaptopurine,methotrexate, and infliximab, all of which areassociated with potentially serious adverseeffects. Patients with Crohn's disease may havecomorbid conditions for which they take prescriptionor OTC medications, vitamins, and supplements.The results of a 5-year retrospective evaluationof polypharmacy in 291 patients withCrohn's disease were reported recently in AlimentaryPharmacology and Therapeutics.

R. K. Cross, MD, and colleagues identifiedminor polypharmacy (2-4 medications) in 37% to40% of the patients and major polypharmacy (≥5medications) in 50% to 57% of the patients. Adirect correlation was demonstrated betweenmajor polypharmacy and women older than 40with disease exceeding 10 years. Polypharmacywas associated with greater disease severity andlower quality-of-life scores, suggesting adversedrug reactions and deleterious drug-drug interactions.Approximately 10% of patients experiencedsymptom improvement on medication withdrawal,particularly of nonsteroidal anti-inflammatorydrugs and aminosalicylates. The authors concludedthat, whenever possible, the use of multipledrug therapy for patients with Crohn's diseaseshould be minimized and that nonessential medicationsshould be discontinued.