Which medicines can precipitate IBD when used on long term basis?

A recent prospective cohort study has shed light on the association between medication use and the development of Inflammatory Bowel Disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). The findings published in Clinical Gastroenterology and Hepatology reveal significant connections between certain medications and heightened odds of incident IBD, providing valuable insights into potential risk factors for this debilitating condition.

The PURE study was conducted by Neeraj Narula and colleagues. The study included 133,137 individuals aged 20 to 80 from 24 countries. Participants completed country-specific validated questionnaires regarding baseline and follow-up medication use. Individuals were prospectively followed up at least every 3 years. The primary outcome measured was the development of IBD, encompassing both CD and UC.

Medication use was categorised into short-term (baseline but not follow-up use) and long-term (baseline and subsequent follow-up use).

• Antibiotics: Individuals who reported baseline antibiotic use had a significantly increased risk of developing IBD, with an adjusted odds ratio (aOR) of 2.81.
  
• Hormonal Medications: The use of hormonal medications was also linked to a higher likelihood of IBD development, with an aOR of 4.43.
• Oral Contraceptives (Females): In females, both previous and current use of oral contraceptives was associated with an increased risk of IBD, with an aOR of 2.17.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Participants using NSAIDs had an elevated odds ratio for IBD, with an aOR of 1.80. Notably, the risk significantly rose for long-term NSAID users, with an aOR of 5.58.

These findings emphasize the importance of understanding the potential consequences of medication use, especially when it comes to antibiotics, hormonal medications, oral contraceptives, and long-term NSAIDs. While these medications are commonly used for various health conditions, this study underscores the need for both patients and healthcare providers to be aware of their potential association with IBD development.

Reference:

Narula, N., Wong, E. C. L., Pray, C., Marshall, J. K., Rangarajan, S., Islam, S., Bahonar, A., Alhabib, K. F., Kontsevaya, A., Ariffin, F., Co, H. U., Al Sharief, W., Szuba, A., Wielgosz, A., Diaz, M. L., Yusuf, R., Kruger, L., Soman, B., Li, Y., … Yusuf, S. Associations of antibiotics, hormonal therapies, oral contraceptives, and long-term NSAIDS with inflammatory bowel disease: Results from the prospective urban rural epidemiology (PURE) study. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association,2023;21(10):2649-2659.e16. https://doi.org/10.1016/j.cgh.2022.11.037