Is early combined immunosuppression safe for older patients with Crohn’s disease?

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Is early combined immunosuppression safe for older patients with Crohn’s disease?

A new study compared the safety and effectiveness of early combined immunosuppression and conventional treatment in older patients with Crohn’s disease.

Crohn’s disease and ulcerative colitis are the two main subtypes of inflammatory bowel disease, a chronic inflammatory condition involving the gut. Inflammatory bowel disease was long believed to be a disease of the young. However, based on recent reports, 10-30% of inflammatory bowel disease patients are over the age of 60 who either develop the disease at an older age or have aged with the disease.

Conventional treatment versus early combined immunosuppression

The treatment of Crohn’s disease is focused on three main goals: inducing and maintaining remission, improving quality of life, and preventing disease-related complications to minimize adverse events.

The conventional treatment used for most patients with Crohn’s disease uses corticosteroids. Although conventional treatment approach helps control symptoms, with time patients become either resistant to or dependent on corticosteroids. In addition, exposure to corticosteroids for long periods of time is associated with an increased risk of mortality.

The other treatment approach for Crohn’s disease is the combined immunosuppressant therapy that uses a biologic agent such as anti-tumor necrosis factor and an immunosuppressive agent such as thiopurines.

Clinical challenges in diagnosis and treatment of Crohn’s disease in older patients

Many studies have examined the challenges in the management of Crohn’s disease. Diagnosis of Crohn’s disease can be difficult in older patients due to the complications associated with physical changes of ageing, associated comorbidities, and atypical presentations.

Adverse events have limited beneficial treatment options in the management of Crohn’s disease in older patients. In addition, the existence of multiple morbidities increases the complexity of therapy and use of multiple drugs in old age elevates the risk of drug interactions and treatment non-compliance. A lack of drug efficacy trials in older adults with Crohn’s disease further limits the physicians to try different treatment options.

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