I am in my 70s and was diagnosed with Crohn's disease about 10 years ago. Recently, my condition has worsened and I have been on all the standard medications used for Crohn's. Now, my doctor has recommended Remicade, and I am wondering if this drug would be safe at my age. I am very active and am in good health, except for the Crohn's.

L.R.

Crohn's disease is a chronic inflammatory disease of the small and large intestine that leads to abdominal pain, diarrhea, weight loss, rectal bleeding and fevers. Until a couple of years ago, the only drugs effective in treating Crohn's were nonspecific anti-inflammatory agents, such as steroids, mesalamine (Sulfasalazine, Asacol) and mercaptopurine. Although these drugs are extremely helpful in controlling Crohn's, a significant number of patients do not respond and go on to suffer complications (bowel obstructions, fistulas) requiring surgery.

Recent research has identified some immune-system compounds that play a key role in Crohn's inflammation. One of these molecules is known as tumor necrosis alpha (TNF-alpha). Researchers then designed an antibody to block the effect of TNF-alpha. Clinical studies using this antibody, also called infliximab (Remicade), produced impressive results.

Remicade, which is given by IV infusion, can dramatically improve the inflammation in patients with Crohn's that is resistant to other therapies. It is also effective in closing fistulas (abnormal connections between the intestine and other organs). Although the effects of one infusion of Remicade tend to be short-lived (a few months), many doctors are giving patients more infusions to maintain remissions and avert the need for surgery.

Based on the limited data that have accumulated over the past two years, it appears that Remicade is a safe drug. Its use is not limited to any age range of Crohn's patients. You should further discuss your treatment options with your gastroenterologist to determine if Remicade would be a good choice for you.