NSAIDs use Safe in Inflammatory Bowel Disease, Reveals Research
USA: Traditionally, nonsteroidal anti-inflammatory drugs (NSAIDs) are avoided among patients with inflammatory bowel disease (IBD) due to concerns of triggering disease flares. But recent real-world data suggest that NSAIDs may be safer in IBD than previously believed.
Analysis of a large insurance claims database has found that prescription NSAID use was not associated with an increased risk of IBD-related hospitalization in patients with ulcerative colitis. However, a small but statistically significant increase in risk was observed among patients with Crohn’s disease. Overall, these findings, published in Arthritis Care & Research, indicate that selected IBD patients, particularly those with ulcerative colitis, may be able to use NSAIDs for musculoskeletal pain with appropriate caution and monitoring.
Building on this evolving perspective, a large retrospective cohort study led by Adam S. Mayer from the University of Pennsylvania examined national trends in NSAID and opioid prescriptions among patients with IBD. Using administrative claims data spanning over two decades (2000–2022), the researchers aimed to better understand prescribing patterns and factors influencing NSAID use in both adult and pediatric populations.
The study led to the following findings:
- The study analysed data from 361,025 patients with inflammatory bowel disease (IBD).
- Prescription NSAID use showed a significant decline over time.
- This decline occurred despite an increase in reported musculoskeletal complaints.
- A gap was observed between rising pain burden and reduced NSAID use.
- NSAID prescription rates remained consistently lower than opioid prescriptions throughout the study period.
- Patients prescribed opioids were more than twice as likely to also receive NSAIDs.
- Osteoarthritis and nonspecific joint pain were strongly associated with NSAID use.
- Patients younger than 18 years and those older than 80 years were significantly less likely to be prescribed NSAIDs.
The findings also highlighted shifts in prescribing practices over time, including a decline in the use of COX-2 selective NSAIDs after the early 2000s and a broader reduction following updated clinical guidelines discouraging NSAID use in IBD. Pediatric patients, in particular, were less likely to receive NSAIDs, even though their safety profile may be comparatively favorable.
Importantly, the study underscores a persistent gap in pain management for patients with IBD. While NSAID use has decreased, opioid prescriptions remain relatively high, raising concerns about reliance on medications associated with greater long-term risks. At the same time, the increasing prevalence of musculoskeletal symptoms suggests that pain remains an under-addressed issue in this population.
The authors emphasise the need for more comprehensive evaluation of NSAID safety in IBD, particularly given their potential as an effective and possibly safer alternative to opioids for managing pain. They suggest that with careful patient selection and monitoring, NSAIDs could play a more balanced role in IBD care.
Overall, the study calls for a re-examination of current prescribing practices, highlighting the importance of optimising pain management strategies while minimising risks in patients living with IBD.
Reference:
Mayer, A. S., Xiao, R., Grossman, A., Bewtra, M., George, M. D., & Weiss, P. F. (2026). Temporal Trends in and Associations With Nonsteroidal Anti-inflammatory Drug Prescription in Adult and Pediatric Patients With Inflammatory Bowel Disease. Arthritis Care & Research, 78(4), 439-448. https://doi.org/10.1002/acr.25650
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