Older Age and Steroid Use Are Associated with Increasing Polypharmacy and Potential Medication Interactions Among Patients with Inflammatory Bowel Disease

Parian, Alyssa; Ha, Christina

doi:10.1097/mib.0000000000000391

Cited by 39 publications

(36 citation statements)

References 43 publications

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“…Starting immunosuppressants or biological therapies in elderly IBD patients is often a challenge for physicians due to comorbidities and polypharmacy. Polypharmacy, reported in 44% of these patients in some cohorts, increases the risk of developing AEs due to drug interactions and errors in medication intake . Moreover, physiological changes in the elderly patients (pancreatic hypofunction, intestinal dysmotility, decreased hepatic mass and blood flow and decreased renal blood flow, and glomerular filtration rate) may impact the pharmacokinetics of orally administered drugs …”

Section: Introductionmentioning

confidence: 99%

Increased risk of thiopurine‐related adverse events in elderly patients with IBD

Calafat¹,

Mañosa²,

Cañete³

et al. 2019

Aliment Pharmacol Ther

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Summary Background Thiopurines are the most widely used immunosuppressants in IBD although drug‐related adverse events (AE) occur in 20%‐30% of cases. Aim To evaluate the safety of thiopurines in elderly IBD patients Methods Cohort study including all adult patients in the ENEIDA registry who received thiopurines. Patients were grouped in terms of age at the beginning of thiopurine treatment, specifically in those who started thiopurines over 60 years or between 18 and 50 years of age. Thiopurine‐related AEs registered in the ENEIDA database were compared. Results Out of 48 752 patients, 1888 started thiopurines when over 60 years of age and 15 477 under 50 years of age. Median treatment duration was significantly shorter for those who started thiopurines >60 years (13 [IQR 2‐55] vs 32 [IQR 5‐82] months; P < .001). Patients starting >60 years had higher rates of all types of myelotoxicity, digestive intolerance and hepatotoxicity. Thiopurines were discontinued due to AEs (excluding malignancies and infections) in more patients starting >60 years (67.2% vs 63.1%; P < .001). Elderly age and female sex were independent risk factors for most AEs. Conclusion In elderly IBD patients, thiopurines are associated with an increased risk of non‐infectious, non‐neoplastic, AEs.

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Section: Introductionmentioning

confidence: 99%

Increased risk of thiopurine‐related adverse events in elderly patients with IBD

Calafat¹,

Mañosa²,

Cañete³

et al. 2019

Aliment Pharmacol Ther

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“…Patients with IBD have greater use of antidepressants, sedatives, and analgesics (including narcotic analgesics) than matched controls [78]. Older patients with IBD are at increased risk of polypharmacy and potential adverse medication interactions [79]. An American study found that half of patients with CD met criteria for polypharmacy [80] and that this finding correlated with decreased quality of life and increased disease activity.…”

Section: Medication Burdenmentioning

confidence: 99%

The Changing Phenotype of Inflammatory Bowel Disease

Moran

Sheehan

Shanahan

2016

Gastroenterology Research and Practice

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It is widely known that there have been improvements in patient care and an increased incidence of Inflammatory Bowel Disease (IBD) worldwide in recent decades. However, less well known are the phenotypic changes that have occurred; these are discussed in this review. Namely, we discuss the emergence of obesity in patients with IBD, elderly onset disease, mortality rates, colorectal cancer risk, the burden of medications and comorbidities, and the improvement in surgical treatment with a decrease in surgical rates in recent decades.

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“…Although recent literature has documented the efficacy and safety of IBD treatments in the elderly,(13–18) there are substantial gaps in our understanding of the special needs and challenges of this patient population. Most clinical trials have excluded or enrolled insufficient numbers of elderly patients, significantly limiting insights into the safety and efficacy of IBD therapy as a function of age.…”

Section: Introductionmentioning

confidence: 99%

Management of Inflammatory Bowel Disease in the Elderly Patient

Ananthakrishnan

Donaldson

Lasch

et al. 2017

Inflammatory Bowel Diseases

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The population of older patients with inflammatory bowel disease (IBD) continues to grow, partly reflecting the aging global population in general. The debilitating effects of IBD compound age-related decrements in health and functional capacity, and make the medical management of older patients with Crohn’s disease and ulcerative colitis distinctly challenging to clinicians. Here, we review the recent literature describing the pharmacologic management of IBD in this population, with focus on the safety, tolerability, and efficacy of common treatment options, such as steroids, immunomodulators, tumor necrosis factor-α antagonists, and integrin antagonists; surgical interventions in older patients are also discussed. Few studies have systematically and prospectively evaluated the clinical challenges in the medical management of IBD in this patient population, leaving a limited evidence base to which clinicians can turn to for guidance. Treatment patterns may thus be suboptimal. For example, prolonged steroid use in the elderly was found to be common, causing significant morbidity from side effects in a particularly vulnerable population. Finally, within the context of a limited evidence base, we discuss common treatment scenarios to define the parameters within which physicians can individualize care for older patients with IBD. Overall, older IBD patients are at higher risk of adverse events and less treatment responsiveness compared with younger patients, underscoring the need for future studies to fully characterize appropriate treatment courses for this population.

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Older Age and Steroid Use Are Associated with Increasing Polypharmacy and Potential Medication Interactions Among Patients with Inflammatory Bowel Disease

Abstract: Article first published online 7 April 2015.Supplemental Digital Content is Available in the Text.

Cited by 39 publications

References 43 publications

Increased risk of thiopurine‐related adverse events in elderly patients with IBD

Increased risk of thiopurine‐related adverse events in elderly patients with IBD

The Changing Phenotype of Inflammatory Bowel Disease

Management of Inflammatory Bowel Disease in the Elderly Patient

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