Top

International Journal of Colorectal Disease

Published in:

Open Access 01-02-2020 | Tuberculosis | Case Report

Elderly-onset Crohn’s disease remarkably responsive to ustekinumab: a case report

Authors: Maho Iwamoto, Kimitoshi Kato, Mitsuhiko Moriyama

Published in: International Journal of Colorectal Disease | Issue 2/2020

Abstract

Background

Crohn’s disease is intractable and is frequently diagnosed in younger people. No clear policies exist regarding medical treatment for seniors with this disease, and its diagnosis and treatment are often hindered by difficulties attributable to comorbidities, complex differential diagnoses, and polypharmacy. We describe an elderly-onset Crohn’s disease patient showing a marked remission-maintaining effect with no adverse events after administration of ustekinumab.

Methods and results

A 75-year-old patient with Crohn’s disease and a history of pulmonary tuberculosis had first presented to our hospital at age 64 years and was hospitalized. Based on physical examinations, colonoscopy, and blood test results, Crohn’s disease was diagnosed. The patient experienced secondary losses of responsiveness to two tumor necrosis factor (TNF)-alpha inhibitors, and after repeated hospital admissions, she was administered ustekinumab. The patient’s symptoms, endoscopic findings, Crohn’s Disease Activity Index, serum albumin, and physical activity levels improved markedly, and disease remission has been maintained for 2 years to date.

Conclusion

Ustekinumab is an effective treatment option for elderly patients with intractable Crohn’s disease when TNF-alpha inhibitors are ineffective.

Jeuring SF, van den Heuvel TR, Zeegers MP, Hameeteman WH, Romberg-Camps MJ, Oostenbrug LE, Masclee AA, Jonkers DM, Pierik MJ (2016) Epidemiology and long-term outcome of inflammatory bowel disease diagnosed at elderly age-an increasing distinct entity? Inflamm Bowel Dis 22:1425–1434. https://doi.org/10.1097/MIB.0000000000000738 CrossRefPubMed

Sturm A, Maaser C, Mendall M, Sturm A, Maaser C, Mendall M, Karagiannis D, Karatzas P, Ipenburg N, Sebastian S et al (2017) European Crohn's and colitis organisation topical review on IBD in the elderly. J Crohns Colitis 11:263–273. https://doi.org/10.1093/ecco-jcc/jjw188 CrossRefPubMed

Cottone M, Kohn A, Daperno M, Armuzzi A, Guidi L, D'Inca R, Bossa F, Angelucci E, Biancone L, Gionchetti P, Ardizzone S, Papi C, Fries W, Danese S, Riegler G, Cappello M, Castiglione F, Annese V, Orlando A (2011) Advanced age is an independent risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol 9:30–35. https://doi.org/10.1016/j.cgh.2010.09.026 CrossRefPubMed

Lobatón T, Ferrante M, Rutgeerts P, Ballet V, Van Assche G, Vermeire S (2015) Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther 42:441–451. https://doi.org/10.1111/apt.13294 CrossRefPubMed

Feagan BG, Sandborn WJ, Gasink C, Jacobstein D, Lang Y, Friedman JR, Blank MA, Johanns J, Gao LL, Miao Y, Adedokun OJ, Sands BE, Hanauer SB, Vermeire S, Targan S, Ghosh S, de Villiers WJ, Colombel JF, Tulassay Z, Seidler U, Salzberg BA, Desreumaux P, Lee SD, Loftus EV Jr, Dieleman LA, Katz S, Rutgeerts P, UNITI–IM-UNITI Study Group (2016) Ustekinumab as induction and maintenance therapy for Crohn's disease. N Engl J Med 375:1946–1960. https://doi.org/10.1056/NEJMoa1602773 CrossRefPubMed

Gniadecki R, Bang B, Bryld LE, Iversen L, Lasthein S, Skov L (2015) Comparison of long-term drug survival and safety of biologic agents in patients with psoriasis vulgaris. Br J Dermatol 172:244–252. https://doi.org/10.1111/bjd.13343 CrossRefPubMed

Wheat CL, Ko CW, Clark-Snustad K, Grembowski D, Thornton TA, Devine B (2017) Inflammatory bowel disease (IBD) pharmacotherapy and the risk of serious infection: a systematic review and network meta-analysis. BMC Gastroenterol 17:52. https://doi.org/10.1186/s12876-017-0602-0 CrossRefPubMedPubMedCentral

Sandborn WJ, Rutgeerts P, Gasink C, Jacobstein D, Zou B, Johanns J, Sands BE, Hanauer SB, Targan S, Ghosh S, de Villiers WJS, Colombel JF, Feagan BG (2018) Long-term efficacy and safety of ustekinumab for Crohn's disease through the second year of therapy. Aliment Pharmacol Ther 48:65–77. https://doi.org/10.1111/apt.14794 CrossRefPubMedPubMedCentral

Hanauer SB, Sandborn WJ, Feagan BG, Gasink C, Jacobstein D, Zou B, Johanns J, Adedokun OJ, Sands BE, Rutgeerts P et al (2019) IM-UNITI: 3 year efficacy, safety, and immunogenicity of ustekinumab treatment of Crohn's disease. J Crohns colitis Jun 3. Pii: jjz110. https://doi.org/10.1093/ecco-jcc/jjz110 [Epub ahead of print]CrossRef

10.

Engel T, Yung DE, Ma C, Pariente B, WIls P, Eliakim R, Ungar B, Ben-Horin S, Kopylov U (2019) Effectiveness and safety of ustekinumab for Crohn's disease; systematic review and pooled analysis of real-world evidence. Dig Liver Dis 51:1232–1240. https://doi.org/10.1016/j.dld.2019.05.002 CrossRefPubMed

11.

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156. https://doi.org/10.1093/gerona/56.3.M146 CrossRefPubMed

12.

Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M, Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2 (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:16–31. https://doi.org/10.1093/ageing/afy169 CrossRefPubMed

13.

Lorenzo-López L, Maseda A, de Labra C, Regueiro-Folgueira L, Rodríguez-Villamil JL, Millán-Calenti JC (2017) Nutritional determinants of frailty in older adults: a systematic review. BMC Geriatr 17:108. https://doi.org/10.1186/s12877-017-0496-2 CrossRefPubMedPubMedCentral

14.

Montero-Fernández N, Serra-Rexach JA (2013) Role of exercise on sarcopenia in the elderly. Eur J Phys Rehabil Med 49:131–143PubMed

15.

Corona LP, de Oliveira Duarte YA, Lebrão ML (2018) Markers of nutritional status and mortality in older adults: the role of anemia and hypoalbuminemia. Geriatr Gerontol Int 18:177–182. https://doi.org/10.1111/ggi.13137 CrossRefPubMed

16.

Qin G, Tu J, Liu L, Luo L, Wu J, Tao L, Zhang C, Geng X, Chen X, Ai X et al (2016) Serum albumin and C-reactive protein/albumin ratio are useful biomarkers of Crohn's disease activity. Med Sci Monit1 22:4393–4400. https://doi.org/10.12659/msm.897460 CrossRef

17.

Ananthakrishnan AN, McGinley EL, Binion DG (2009) Inflammatory bowel disease in the elderly is associated with worse outcomes: a national study of hospitalizations. Inflamm Bowel Dis 15:182–189. https://doi.org/10.1002/ibd.20628 CrossRefPubMed

18.

Toruner M, Loftus EV Jr, Harmsen WS, Zinsmeister AR, Orenstein R, Sandborn WJ, Colombel JF, Egan LJ (2008) Risk factors for opportunistic infections in patients with inflammatory bowel disease. Gastroenterology 134:929–936. https://doi.org/10.1053/j.gastro.2008.01.012 CrossRefPubMed

19.

Brassard P, Bitton A, Suissa A, Sinyavskaya L, Patenaude V, Suissa S (2014) Oral corticosteroids and the risk of serious infections in patients with elderly-onset inflammatory bowel diseases. Am J Gastroenterol 109:1795–1802. https://doi.org/10.1038/ajg.2014.313 CrossRefPubMed

Title: Elderly-onset Crohn’s disease remarkably responsive to ustekinumab: a case report
Authors: Maho Iwamoto
Kimitoshi Kato
Mitsuhiko Moriyama
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Tuberculosis
Infliximab
Crohn's Disease
Chronic Inflammatory Bowel Disease
Adalimumab
Ustekinumab
Tuberculosis
Published in: International Journal of Colorectal Disease / Issue 2/2020
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03476-y

At a glance: The STEP trials

Springer Medicine

Elderly-onset Crohn’s disease remarkably responsive to ustekinumab: a case report

Abstract

Background

Methods and results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods and results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2020

A minimally invasive, endoscopic transgluteal procedure for pudendal nerve and inferior cluneal nerve neurolysis in case of entrapment: 3- and 6-month results. The ENTRAMI technique for neurolysis

The effect of preemptive use of pregabalin on postoperative morphine consumption and analgesia levels after laparoscopic colorectal surgery: a controlled randomized trial

High-grade intratumoral tumor budding is a predictor for lymphovascular invasion and adverse outcome in stage II colorectal cancer

Effect of nationwide screening program on colorectal cancer mortality in Taiwan: a controlled interrupted time series analysis

Incidence and prognosis of pulmonary metastasis in colorectal cancer: a population-based study

Genetic polymorphism patterns suggest a genetic driven inflammatory response as pathogenesis in appendicitis