Combined Immunosuppression Effective for Older Patients with Crohn Disease

A new Alimentary Pharmacology & Therapeutics study indicates that older patients with Crohn disease can be safely and effectively treated with combined immunosuppression, despite previous reluctance by health care professionals to use the practice due to safety concerns.

According to the press release, among the 1981 patients in the study, 311 were aged 60 years or older. One-hundred and seventy-three participants were randomized to early combined immunosuppression and 138 to conventional management. Over 24 months, 10% of older patients developed Crohn disease-related complications (6.4% of those in the combined immunosuppression group versus 14.5% of those in the conventional management group) and 14 patients died (3.5% versus 5.8%, respectively).

Among the patients who received combined immunosuppression in the study, older patients experienced remission of their disease to a similar extent as those aged under 60 years. There was also no increase in adverse effects from these medicines in older patients.

"It is important to treat aggressive Crohn disease appropriately regardless of age," said lead author Dr. Siddharth Singh, of the University of California San Diego, in a press release. "This may include early step-up combination therapy of tumor necrosis factor-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."