Mesalamine most commonly prescribed Crohn’s disease treatment among older patients
SAN ANTONIO — Older patients with Crohn’s disease were less likely to receive biologic agents and more than twice as likely to receive mesalamine compared with younger patients, according to data presented at the American College of Gastroenterology Annual Meeting.
Researchers observed these findings from data on patients enrolled in TARGET-IBD, an observational cohort of more than 3,000 patients with inflammatory bowel disease receiving usual care at 34 community and academic practices across the United States.
“The idea behind the cohort is to follow patients over time so we can look at real-world treatment patterns, real-world effectiveness of therapies, and to really think about how we are treating patients with IBD across a variety of different scenarios,” Edward L. Barnes, MD, MPH, assistant professor of medicine at the University of North Carolina at Chapel Hill, told Healio Gastroenterology and Liver Disease. “In this particular study, what we are looking at is, how do we treat patients who are older in disease onset compared to patients who are younger?”
For the current analysis, Barnes and colleagues examined treatment patterns of approximately 2,000 patients with ulcerative colitis and Crohn’s disease. They compared medication use among the following groups:
- patients aged younger than 30 years;
- patients aged 30 years to 49 years;
- patients aged 50 years to 65 years; and
- patients older than 65 years.
“We found a couple of interesting trends,” Barnes said. “The one that jumps out the most is that mesalamine was by far the most common medication prescribed across both the older ulcerative colitis population, which makes a lot of sense, and then also across the older Crohn’s disease population.”
In the ulcerative colitis cohort, 77% of patients aged older than 65 years received mesalamine vs. 57.6% of patients younger than 30 years, 74.4% of patients aged 30 to 49 years and 68.1% of patients aged 50 to 65 years. In the Crohn’s disease cohort, 34.1% of patients aged older than 65 years received mesalamine vs. 16.1% of patients younger than 30 years, 17.9% of patients aged 30 to 49 years and 25% of patients aged 50 to 65 years.
“I think that is a little bit concerning because we do not think about mesalamine as being one of the more effective medications for the treatment of Crohn’s disease, but it was the most common medication used among patients with Crohn’s disease greater than age 65,” Barnes said.
Additional findings showed that older patients were less likely to receive anti-TNF therapy for ulcerative colitis (P = .0017) and Crohn’s disease (P < .0001) compared with younger patients. There was no significant difference in the use of the anti-IL-12/23 ustekinumab (Stelara, Janssen), which was below 1% across all age groups in the ulcerative colitis population, and 10% or less across all age groups in the Crohn’s disease population. Further, there was no significant difference in the use of immunomodulators such as thiopurines among older vs. younger patients.
“That was a little bit counter-intuitive to us because we know there are safety issues with thiopurines,” Barnes said. “If we are prescribing so much mesalamine in the older population, presumably because of concerns about safety and immunosuppression with other medicines, that safety issue is still there with thiopurines.”
The researchers’ next big step is to further investigate the safety and efficacy of IBD treatments in the TARGET-IBD cohort, according to Barnes.
“We laid the groundwork of exploring how often patients are using these medicines, so now we can really start to see whether they are effective,” he said. “Are they more or less effective among older patients? What are the safety signals, or lack thereof? If certain medicines are not less safe in the older population, then maybe we should be using them more often instead of mesalamine, which we do not think is as effective in Crohn’s disease. Exploring this is the next logical step for us to take.” – by Stephanie Viguers
Barnes E, et al. P1394. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.
Disclosure: Barnes reports being a consultant for AbbVie. Please see the abstract for all other authors’ relevant financial disclosures.