Medication use before IBD Dx

February 12, 2024

Issue 04

Clinical Question

Do patterns of medication use predict future risk of IBD?

Editor’s Bottom Line

Studying profiles of medication use may help to identify individuals who are developing IBD and facilitate more prompt diagnosis.

Reference

Bonfils L, Karachalia Sandri A, Poulsen GJ, et al. Medication-Wide Study: Exploring Medication Use 10 Years Before a Diagnosis of Inflammatory Bowel Disease. Am J Gastroenterol. 2023;118(12):2220–29; https://journals.lww.com/ajg/abstract/2023/12000/medication_wide_study__expl oring_medication_use_10.25.aspx

Synopsis

This study analysed prescription and diagnostic data from 29,219 adults diagnosed with IBD in Denmark between 2005 and 2018 and from 292,190 matched Danish controls without IBD. Researchers examined use of prescription medications up to 15 years prior to an IBD diagnosis or the date of control matching.

The median age at IBD diagnosis was 43, roughly half of IBD patients were women, 30% had Crohn’s disease (CD) and 67% had ulcerative colitis (UC).

The analysis found that 10 years prior to IBD diagnosis or matching date, the IBD population had 1.8 times more users of immunologic medications, 1.4 times more users of medications for gastrointestinal conditions and 1.2 times more users of medications for cardiovascular, dermatologic, endocrinological, neurological, psychiatric, musculoskeletal, respiratory and blood-forming organ diseases, compared to the control population (p<0.0001). Two years before diagnosis, there was a sharp rise in the use of medications for gastrointestinal and metabolic disease and for cardiovascular, endocrinological, infectious, neoplastic, immunological and parasitic diseases in the IBD population, compared to the control group.

The finding of greater pre-diagnosis medication use was strongest among those with CD, but persisted across UC patients as well, and also across age groups and sexes.

An analysis of prescription claims data 15 years prior to IBD diagnosis for 19,486 of those with IBD included in the study found that IBD patients again used more medications in 10 of 14 drug groups at that time, compared to matched controls. This finding was stronger in the CD population.

Finally, an analysis excluding 26.3% and 19.1% of IBD and matched control patients, respectively, who had one or more diagnoses of other immune-mediated inflammatory diseases (IMID) 10 years prior to IBD diagnosis or matching date found there was still greater medication use among IBD patients across 10 of 14 medication classes, with an attenuated signal for immunologic medications.

Details

Study Design: Observational
Funding: The Danish National Research Foundation
Allocation: None
Setting: Multicenter
Level of Evidence: 2b