Optimal Management of Biologics in Crohn’s Disease - Episode 11
Dr Bincy P. Abraham examines age considerations and comorbidities when choosing a therapy for elderly patients with Crohn’s disease.
David P. Hudesman, MD: Earlier you we were talking about selecting the right therapy for the right patient. What about our elderly patients?
Bincy P. Abraham, MD, MS, AGAF, FACG: Of course, we talk about age, it is just a number. I am getting older. But we must consider, we have an elderly patient, but what does that mean? Age is just a number. I have very healthy 75 and 80 year old’s who are still running marathons. And I'm impressed, I'm thinking I wish I could be like them when I turned 75 to 80. And I have a frail 55 year old, they've had multiple cardiac issues, had bypasses have, or had pulmonary issues. Age does matter in a certain sense, but as we get older, we tend to have more comorbidity, we need to take that into account. But again, regardless of that, we must look at how healthy is that patient? Is it a frail elderly? Or is it a healthy elderly? And that helps me decide on appropriate therapy. In certain cases where I discussed earlier, this person had significant congestive heart failure, well, anti-TNF are out of the question. But our newer agents, the safety profile has been quite spectacular with that I can say, in comparison to our older medications. That it becomes less of a concern when I'm choosing a therapy for my frail, elderly patient, regardless of the age. But of course, we discuss that and sometimes patients may read labels that may have like maybe one incident of a case and of course it's on the label, and I must go ahead and explain, you don't fit this criterion because you don't have this risk factor, I wouldn't want you to worry about this risk or potential adverse effect of this medication. I'm not negating that, you know, potential adverse effects can't occur but that can happen with any medical therapy that we choose. But we must consider though overall, take the forest for the trees, look at all the aspects of that patient, how healthy are they? What are their comorbidities? Yes, age. But again, are they frail or not in that sense? And then with the newer medications. Well, if there's no real contraindication to doing it, I'll explain the safety profile and make sure that patient is comfortable taking that therapy or initiating that therapy. Now, if I have a patient who, let's say, I may be concerned because they have so many comorbidities, I will pick up the phone and consult with their cardiologist or pulmonologist or oncologist if they had prior history of cancer to just confirm and make sure that this OK. I rarely must do that with our newer medications because of such a great safety profile.
Transcript Edited for Clarity