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Older Patients With Crohn Disease May Benefit From Early Combo Tx

Early step-up combo therapy includes tumor necrosis factor-α antagonist plus an antimetabolite

MONDAY, April 8, 2019 (HealthDay News) — A post hoc analysis of data from a randomized trial shows no difference between older and younger patients for the safety and efficacy of early combined immunosuppression therapy compared with conventional management for Crohn disease, according to a study published online March 19 in Alimentary Pharmacology and Therapeutics.

Siddharth Singh, M.D., from the University of California in San Diego, and colleagues conducted a post hoc analysis of the REACT (Randomized Evaluation of an Algorithm for Crohn’s Treatment) trial to evaluate the impact of age (<60 versus ≥60 years) on the risk for Crohn disease-related complications in patients treated with early combined immunosuppression (tumor necrosis factor-α antagonist plus antimetabolite [thiopurines or methotrexate]) and sequentially escalated in a stepwise algorithm versus conventional management. Efficacy at 24 months was defined as the time to major adverse outcome of Crohn disease-related surgery, hospitalization or serious complications, and corticosteroid-free clinical remission.

The researchers report that of the 1,981 patients, 15.7 percent were ≥60 years (173 randomly assigned to early combined immunosuppression and 138 to conventional management). Ten percent of older patients developed Crohn disease-related complications over 24 months (early combined immunosuppression, 6.4 percent; conventional management, 14.5 percent) and 14 patients died (3.5 and 5.8 percent, respectively). There was no difference in achieving corticosteroid-free clinical remission between younger patients (early combined immunosuppression, 72.6 percent; conventional management, 64.4 percent; relative risk, 1.06; 95 percent confidence interval [CI], 0.98 to 1.15) and older patients (early combined immunosuppression, 74.8 percent; conventional management, 63.0 percent; relative risk, 1.09; 95 percent CI, 0.90 to 1.33; P-interaction = 0.78). There was also no age-related difference in time to major adverse outcome between early combined immunosuppression and conventional management (<60 years: hazard ratio, 0.71 [95 percent CI, 0.53 to 0.96]; ≥60 years: hazard ratio, 0.69 [95 percent CI, 0.31 to 1.51]; P-interaction = 0.92).

“Early combined immunosuppression may be considered as a treatment option in selected older patients with Crohn disease with suboptimal disease control,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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