Early combination therapy similarly effective in older patients with Crohn’s

SAN DIEGO — Older patients with inflammatory bowel disease should be considered candidates for early combined immunosuppressive therapy, according to research presented at Digestive Disease Week.

In his presentation, Siddharth Singh, MD, of the University of California San Diego, said older patients with IBD are at higher risk for complications and adverse outcomes, but there is still apprehension about using biologics in that population. Singh and colleagues sought to evaluate the impact of age on risk for CD-related complications in patients treated with early combined immunosuppression compared with conventional management.

“We hypothesized that early combined immunosuppression will be similarly effective in older and younger patients, and overall, would be more effective than conventional management,” Singh said in his presentation.

Researchers compared efficacy (corticosteroid-free clinical remission based on the Harvey-Bradshaw Index, time to composite major adverse outcome of CD-related surgery, hospitalization or disease-related complications of fistula, abscess or stricture) and safety outcomes (drug-related complications and death) at 24 months, between patients aged at least 60 years and patients aged younger than 60 years. They randomly assigned 1,981 patients to receive either early combined immunosuppression or conventional management.

The study comprised 311 patients aged at least 65 years, 173 of whom received early combined immunosuppression.

Investigators found no difference in the magnitude of benefit with early combined immunosuppression compared with conventional management in younger vs. older patients on time to occurrence of composite major adverse outcome (HR = 0.74; 95% CI, 0.56-0.98 vs. HR = 0.67, 95% CI, 0.32-1.4).

Although mortality was higher among the older cohort of patients, more deaths were seen in the older group on conventional management compared with early combined immunosuppression (5.8% vs. 3.5%).

“In selected older patients with suboptimal disease control, such an algorithmic treatment step-up strategy may be considered, to decrease treatment disutility and avoid persistence on chronic corticosteroids,” Singh concluded. – by Alex Young

Reference:

Singh S, et al. Abstract 209. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Singh reports financial ties to AbbVie, Pfizer and Takeda. Please see the meeting disclosure index for all other authors’ relevant financial disclosures.