Safety and potential interaction of immunosuppressive drugs for the treatment of inflammatory bowel disease in elderly patients

Minerva Gastroenterol (Torino). 2021 May 31. doi: 10.23736/S2724-5985.21.02919-3.Online ahead of print.

Ylenia Ingrasciotta 1 2, Mauro Grova 3 4, Federica Crispino 3 4, Valentina Isgró 5, Fabrizio Calapai 6, Fabio S Macaluso 3, Francesco Mattace-Raso 7, Gianluca Trifiró 5, Ambrogio Orlando 3


Author information

  • 1Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands - ylenia.ingrasciotta@unime.it.
  • 2Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy - ylenia.ingrasciotta@unime.it.
  • 3Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy.
  • 4Section of Gastroenterology & Hepatology, Internal Medicine and Medical Specialties, PROMISE, Department of Health Promotion Sciences Maternal and Infant Care, University of Palermo, Palermo, Italy.
  • 5Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
  • 6Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy.
  • 7Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.


Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, are chronic diseases associated with increased morbidity and reduced quality of life. Age may represent a risk factor for adverse events, due to the multimorbidity and polypharmacy, common in elderly patients. Elderly are often not included in clinical trials evaluating efficacy and safety of study drugs for the treatment of inflammatory bowel diseases. Several drugs, such as aminosalicylates, systemic corticosteroids, immunosuppressant drugs, biological drugs and Janus Kinase inhibitors, are available for the management of inflammatory bowel diseases. With the increasing spectrum of therapeutic options, it is therefore important to analyze the evidence regarding the safety of the use of these agents in elderly patients. Selection of immunosuppressive therapy is a challenge in the management of elderly patients with inflammatory bowel diseases, for whom biologics with a lower risk of infection or cancer, such as vedolizumab and ustekinumab, may be preferred in elderly patients. Concomitant therapies and comorbidities must be thoroughly investigated before initiating any immunosuppressive or biological therapy in order to minimize the risk of drug-drug interactions. This review aims to provide an overview of the safety of thiopurines, methotrexate and target therapies as well as their drug-drug interactions in patients with inflammatory bowel diseases.



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