Trial reportAlimentary pharmacology & therapeutics2019
Early combined immunosuppression may be effective and safe in older patients with Crohn's disease: post hoc analysis of REACT.
Trial report in Alimentary pharmacology & therapeutics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01030809 (A Cluster Randomized Controlled Trial of a Treatment Algorithm for the Management of Crohn's Disease), which is not on this map. Cited by 26 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Cluster Randomized Controlled Trial of a Treatment Algorithm for the Management of Crohn's Disease
Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Progression of Elderly Onset Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis of Population-Based Cohort Studies.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2020Pooled it
- Similar Efficacy of Mesalazine in Adult and Older Adult Ulcerative Colitis Patients: Post Hoc Analysis of a Randomized Noninferiority Trial of 1600 mg vs 400 mg Tablets.Inflammatory bowel diseases · 2025Trial
- Effects of Age on Inflammatory Bowel Disease Presentation and Management in Older Adults.Digestive diseases and sciences · 2026Review
- Disease phenotype affects treatment of late-onset inflammatory bowel disease: Analysis of a large UK cohort.Inflammatory bowel diseases · 2026Observational
- Update in Inflammatory Bowel Disease Management in the Elderly.Current gastroenterology reports · 2025Review
- Age as a Predictor of Serum Tumor Necrosis Factor Antagonist Drug and Antidrug Antibody Concentrations in Inflammatory Bowel Disease-A Nationwide Cohort Study.Journal of clinical medicine · 2025Article
- Could immunotherapy and regulatory T cells be used therapeutically to slow the progression of Alzheimer's disease?Brain communications · 2025Review
- Early Endoscopic Outcomes After Risankizumab Are Associated With Fewer Hospitalizations and Surgeries in Crohn's Disease.Gastro hep advances · 2025Article
- Older Adults With Inflammatory Bowel Disease Are at Higher Risk of Developing Antibodies to Infliximab.Inflammatory bowel diseases · 2024Article
- Combination treatment of inflammatory bowel disease: Present status and future perspectives.World journal of gastroenterology · 2024Article
- Optimal Management of Refractory Crohn's Disease: Current Landscape and Future Direction.Clinical and experimental gastroenterology · 2024Review
- Management Considerations for the Older Adult With Inflammatory Bowel Disease.Gastroenterology & hepatology · 2023Article
- The 2023 Impact of Inflammatory Bowel Disease in Canada: Special Populations-IBD in Seniors.Journal of the Canadian Association of Gastroenterology · 2023Review
- Hemorrhagic gastric ulcer in a patient with Behcet's disease successfully treated with infliximab.DEN open · 2023Article
- Personalize, participate, predict, and prevent: 4Ps in inflammatory bowel disease.Frontiers in medicine · 2023Review
- Ileal Pouch-Anal Anastomosis in the Older Adult: a Review of Postoperative Outcomes and Pouchitis Treatment.Current treatment options in gastroenterology · 2022Article
- Frailty and Risk of Serious Infections in Biologic-treated Patients With Inflammatory Bowel Diseases.Inflammatory bowel diseases · 2021Article
- Frailty Is Independently Associated with Mortality and Readmission in Hospitalized Patients with Inflammatory Bowel Diseases.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2021Article
- Clinical Characteristics and Long-term Prognosis of Elderly-Onset Ulcerative Colitis in a Population-Based Cohort in the Songpa-Kangdong District of Seoul, Korea.Gut and liver · 2021Article
- Disease- and Treatment-related Complications in Older Patients With Inflammatory Bowel Diseases: Comparison of Adult-onset vs Elderly-onset Disease.Inflammatory bowel diseases · 2021Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundPhysicians may be reluctant to prescribe combined immunosuppression in older patients with Crohn's disease due to perceived risk of treatment-related complications.
aimTo evaluate the impact of age on risk of Crohn's disease-related complications in patients treated with early combined immunosuppression vs conventional management in a post hoc analysis of the randomised evaluation of an algorithm for Crohn's treatment (REACT), a cluster-randomised trial.
methodsWe compared efficacy (time to major adverse outcome of Crohn's disease-related surgery, hospitalisation or serious complications; corticosteroid-free clinical remission) and safety outcomes at 24 months, between patients aged <60 vs ≥60 years randomised to early combined immunosuppression or conventional management, using Cox proportional hazard analysis or modified Poisson model. In the early combined immunosuppression arm, patients with failure to achieve clinical remission within 4-12 weeks of corticosteroids were treated with a combination of tumour necrosis factor-α antagonist plus anti-metabolite and sequentially escalated in a stepwise algorithm.
resultsOf 1981 patients, 311 were ≥60 years (15.7%; 173 randomised to early combined immunosuppression and 138 to conventional management). Over 24 months, 10% of older patients developed Crohn's disease-related complications (early combined immunosuppression vs conventional management: 6.4% vs 14.5%) and 14 patients died (3.5% vs 5.8%). There was no difference between younger and older patients in risk of achieving corticosteroid-free clinical remission (<60 years, early combined immunosuppression (72.6%) vs conventional management (64.4%): relative risk [RR], 1.06 [95% CI, 0.98-1.15] vs ≥60 years, early combined immunosuppression (74.8%) vs conventional management (63.0%): RR, 1.09 [0.90-1.33], P-interaction = 0.78) or time to major adverse outcome (<60 years: hazard ratio [HR], 0.71 [0.53-0.96] vs ≥60 years: HR, 0.69 [0.31-1.51], P-interaction = 0.92) with early combined immunosuppression vs conventional management.
conclusionsWe observed no difference in efficacy and safety of early combined immunosuppression compared to conventional management in older and younger patients. Early combined immunosuppression may be considered as a treatment option in selected older patients with Crohn's disease with suboptimal disease control. Clinical Trial Identifier: NCT01030809.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.