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Clinical Considerations Regarding the Use of Thiopurines in Older Patients with Inflammatory Bowel Disease

  • Therapy in Practice
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Abstract

The number of older patients with inflammatory bowel disease (IBD) is increasing due to both improvements in the life expectancy of patients with long-lasting IBD and later onset of the disease. In spite of a less aggressive IBD phenotype, disease management in older patients is hampered by comorbidities and polypharmacy (which increase the risk of drug-related adverse events and errors in medication intake) and also by an increased risk of the infections and malignancies associated with the immunosuppressive drugs that are frequently used to treat IBD. Thiopurines are the most frequently used immunosuppressive drugs in IBD, though they are often discontinued due to adverse events. However, when tolerated, thiopurines are efficient in the maintenance of remission in ulcerative colitis and Crohn’s disease. In fact, thiopurines still have a role to play in the treatment algorithm of older patients with IBD because anti-tumor necrosis factor agents do not provide clear advantages for this population in terms of their safety profile, while data on the new biological drugs are still scarce. In this article, we review the optimal use of thiopurines in older patients with IBD.

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Authors and Affiliations

  1. Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain

    Margalida Calafat, Míriam Mañosa, Fiorella Cañete & Eugeni Domènech

  2. Centro de Investigaciones Biomédicas en Red de Enfermedades Hepaticas y Digestivas, Madrid, Spain

    Margalida Calafat, Míriam Mañosa, Fiorella Cañete & Eugeni Domènech

  3. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain

    Eugeni Domènech

Authors
  1. Margalida Calafat
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  2. Míriam Mañosa
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  3. Fiorella Cañete
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  4. Eugeni Domènech
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Correspondence to Eugeni Domènech.

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MC has served as a speaker or has received research or education funding or advisory fees from Takeda, Janssen, Faes Farma, and MSD; FC has served as a speaker or has received research or education funding or advisory fees from Takeda, Janssen, MSD, and Ferring; MM has served as a speaker or has received research or education funding or advisory fees from FAES, Ferring MSD, AbbVie, Takeda, and Janssen; ED has served as a speaker and has received research and educational funding and advisory fees from MSD, AbbVie, Takeda, Celltrion, Samsung Bioepis, Kern Pharma, Pfizer, Janssen, Celgene, Adacyte Therapeutics, Otsuka Pharmaceuticals, Ferring, Shire Pharmaceuticals, Tillots, Thermofisher, Grifols, Gilead, Roche, and Gebro.

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MC and ED drafted the manuscript. MM and FC critically reviewed the manuscript and added valuable contributions. All the authors approved the final version of the manuscript.

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Calafat, M., Mañosa, M., Cañete, F. et al. Clinical Considerations Regarding the Use of Thiopurines in Older Patients with Inflammatory Bowel Disease. Drugs Aging 38, 193–203 (2021). https://doi.org/10.1007/s40266-020-00832-4

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  • DOI: https://doi.org/10.1007/s40266-020-00832-4

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