August 20, 2019
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Older patients with IBD at higher risk for thiopurine-related adverse events

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Among patients with inflammatory bowel disease older than 60 years, thiopurines were associated with an increased risk for non-infectious and non-neoplastic adverse events, according to study results.

Míriam Mañosa, of the IBD Unit at Hospital Universitari Germans Trias i Pujol in Spain, and colleagues wrote that starting immunosuppressant therapy in older patients with IBD can be difficult because of the associated comorbidities and polypharmacy.

“Physiological changes in the elderly patients may impact the pharmacokinetics of orally administered drugs,” they wrote in Alimentary Pharmacology & Therapeutics. “Although some studies have reported an increasing rate of thiopurine-related adverse events with age among female patients with Crohn’s disease, no studies have specifically assessed the safety profile of thiopurines in elderly patients.”

Researchers analyzed data from the ENEIDA registry comprising 48,752 patients with IBD. They grouped patients based on their age at the beginning of thiopurine therapy — over 60 years (n = 1,888) or between 18 and 50 years (n = 15,477) — and compared thiopurine-related adverse events between the groups.

Mañosa and colleagues found that compared with the younger cohort of patients, patients older than 60 years had higher rates of all types of myelotoxicity (7.6% vs. 14%; P < .001), digestive intolerance (10% vs. 12.3%; P = .002) and hepatotoxicity (4.7% vs. 9%; P < .001). More patients in the older cohort discontinued thiopurine therapy due to adverse events, excluding malignancies and infections (67.2% vs. 63.1%; P < .001).

Additionally, Mañosa and colleagues found that older age and female sex were independent risk factors for most adverse events.

“Our findings very likely reflect reduced drug clearance in elderly patients and in females and suggest that dosing guidelines should recommend consideration of lower starting doses or close monitoring of drug metabolites in these populations,” they concluded. – by Alex Young

Disclosures: Mañosa reports serving as a speaker, consultant and advisory board member for AbbVie, Allergan, Almirall, Danone, Janssen, MSD and Takeda. Please see the full study for all other authors’ relevant financial disclosures.