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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<\/i>.<\/p>\n
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 \u226560 years) on the risk for Crohn disease-related complications in patients treated with early combined immunosuppression (tumor necrosis factor-\u03b1 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.<\/p>\n
The researchers report that of the 1,981 patients, 15.7 percent were \u226560 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]; \u226560 years: hazard ratio, 0.69 [95 percent CI, 0.31 to 1.51]; P-interaction = 0.92).<\/p>\n
“Early combined immunosuppression may be considered as a treatment option in selected older patients with Crohn disease with suboptimal disease control,” the authors write.<\/p>\n
Several authors disclosed financial ties to the pharmaceutical industry.<\/p>\n