Combined immunosuppression may be effective, safe in treating older patients with Crohn’s disease

Combining medications that suppress the immune system has been successful in treating young patients with Crohn's disease, but some physicians have been reluctant to use this strategy in older patients because of concerns about safety. Now an Alimentary Pharmacology & Therapeutics study indicates that older patients can be safely and effectively treated with such combined immunosuppression as well.

Among the 1,981 patients in the study, 311 were aged 60 years or older (173 randomized to early combined immunosuppression and 138 to conventional management). Over 24 months, 10 percent of older patients developed Crohn's disease-related complications (6.4 percent of those in the combined immunosuppression group versus 14.5 percent of those in the conventional management group) and 14 patients died (3.5 percent versus 5.8 percent).

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 side effects from these medicines in older patients.

"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 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."