Early Combined Immunosuppression Appears Safe in Elderly With Crohn Disease

Early combined immunosuppression can be safe and effective among older individuals with Crohn disease (CD), according to findings from a post hoc analysis of the Randomised Evaluation of an Algorithm for Crohn's Treatment (REACT) trial.

The researchers analyzed data on 1981 participants from the REACT study, an open-label cluster randomized controlled trial performed throughout community gastroenterology practices in Belgium and Canada. The practices were randomly assigned to administer early combined immunosuppression (ECI) or conventional management to patients with CD over 2 years.

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Among 311 participants aged 60 years or older, 173 received ECI and 138 received conventional management.

Participants in the ECI group who did not achieve clinical remission within 4 to 12 weeks of corticosteroid use were treated with a combination of tumor necrosis factor α antagonist plus antimetabolite and were sequentially escalated in a stepwise algorithm.

Safety and efficacy of ECI and conventional management were compared among participants aged 60 years or older and participants aged 59 years or younger.

Overall, 10% of older participants developed CD-related complications (6.4% in the ECI group vs 14.5% in the conventional management group) and 14 patients died (3.5% in the ECI group vs 5.8% in the conventional management group).

Among the older participants, corticosteroid-free clinical remission was achieved by 74.8% in the ECI group and 63% in the conventional management group. Among the younger participants, corticosteroid-free clinical remission was achieved by 72.6% in the ECI group and 64.4% in the conventional management group.

“We observed no difference in efficacy and safety of early combined immunosuppression compared to conventional management in older and younger patients,” the researchers concluded. “Early combined immunosuppression may be considered as a treatment option in selected older patients with CD with suboptimal disease control.”

—Colleen Murphy

Reference:

Singh S, Stitt LW, Zou G, et al. Early combined immunosuppression may be effective and safe in older patients with Crohn’s disease: post hoc analysis of REACT [published online March 19, 2019]. Aliment Pharmacol Ther. doi:10.1111/apt.15214.