Association of pain meds with IBD flares 'inconsistent'

Reuters Health Information: Association of pain meds with IBD flares 'inconsistent'

Association of pain meds with IBD flares 'inconsistent'

Last Updated: 2018-04-09

By Marilynn Larkin

NEW YORK (Reuters Health) - Contrary to generally accepted belief, there is no consistent association between acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), or COX-2 inhibitor use and the risk of inflammatory bowel disease (IBD) exacerbations, a new analysis suggests.

Dr. Hamed Khalili of Massachusetts General Hospital and Harvard Medical School in Boston and colleagues investigated these associations in a systematic review and meta-analysis that included 18 studies published between 1983 and 2016.

As reported online April 5 in Alimentary Pharmacology and Therapeutics, pooled relative risks of disease exacerbation with NSAIDs use were 1.42 for Crohn's disease and 1.52 for ulcerative colitis.

The corresponding values for acetaminophen use were 1.40 for ulcerative colitis and 1.56 for inflammatory bowel disease.

However, sensitivity analyses limited to studies with a low risk of bias showed a significantly increased risk of risk of Crohn's disease exacerbation (1.53) with NSAIDs use, but not for ulcerative colitis.

There were insufficient data to conduct a meta-analysis of COX-2 inhibitor use and IBD flares.

Study limitations included wide variation across studies in definitions of disease exacerbation; potential confounding by indication, since some studies did not document the reason for acetaminophen use; and lack of power to detect modest associations.

Dr. Khalili told Reuters Health, "We did not find a consistent association between use of NSAIDs and risk of IBD exacerbations. This was surprising to us, as generally clinicians advise against use of NSAIDs in patients with established inflammatory bowel disease."

However, he added, "we caution against any changes in current practice; significantly more work is required to examine the safety of acetaminophen and NSAIDs in patients with Crohn's disease and ulcerative colitis."

Dr. Ellen Scherl, a gastroenterologist at NewYork-Presbyterian and Weill Cornell Medicine in New York City, pointed out, "The meta-analysis looks at a small number of studies with a small number of patients and many of the trials are retrospective studies."

"Larger, well designed prospective studies examining the relationship between NSAIDs and acetaminophen and inflammatory bowel disease / ulcerative colitis disease activity are warranted," she said in an email to Reuters Health.

"I recommend a prospective study looking at qualitative patient-reported symptoms as well as quantitative disease activity indices - e.g., Ulcerative Colitis Disease Activity Index, Crohn's Disease Activity Index, Bath Ankylosing Spondylitis Disease Activity Index - and inflammation biomarkers, including CRP and fecal calprotectin," Dr. Scherl concluded.

The study was funded in part by AbbVie, Samsung Bioepsis, and Takeda Pharmaceuticals. Dr. Khalili receives fees from all three companies.


Aliment Pharmacol Ther 2018.

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