Polypharmacy may fuel disease flare in ulcerative colitis

Last Updated: 2018-10-18

By Megan Brooks

NEW YORK (Reuters Health) - A substantial number of patients with ulcerative colitis (UC) are taking multiple prescription and over-the-counter medications unrelated to UC, which could increase their risk of disease flare, according to a new study.

"The take home from this study is the importance of reviewing medications with patients at each clinic visit," Dr. Jingzhou Wang from University of Virginia, Charlottesville, noted in an interview with Reuters Health.

He presented his research October 9 at the American College of Gastroenterology annual meeting in Philadelphia.

"Polypharmacy is a documented clinical problem in many chronic diseases and it can be associated with adverse patient outcomes, but nobody has really investigated the polypharmacy issue in UC," Dr. Wang explained.

He and his colleagues assessed patient-specific characteristics associated with polypharmacy in UC patients and the impact of polypharmacy (prescription and non-prescription medications) on disease outcomes.

They reviewed the electronic medical records of 457 patients with UC who visited a tertiary medical center outpatient clinic from 2004 to 2016. The outcomes of interest were UC disease flare, therapy escalation, IBD-related hospitalization and surgery within five years of their initial visit.

Major polypharmacy (use of five or more non-UC medications) was identified in roughly 30% of patients and minor polypharmacy (use of two to four non-UC medications) was seen in 41%.

"Not surprisingly," said Dr. Wang, polypharmacy was more common in people who were older, female, as well as those with functional GI disorders and psychiatric disease (anxiety or depression).

After adjusting for multiple confounders, major polypharmacy was significantly associated with increased risk of disease flare (odds ratio, 3.80, 95% confidence interval: 1.57 - 9.20), with a trend in the minor polypharmacy group (OR 1.15; 95% CI: 0.59 - 2.22). Major or minor polypharmacy was not associated with therapy escalation, IBD-related hospitalization or surgery.

In an analysis of specific medication categories, baseline use of narcotic pain medication was associated with more than a three-fold increased risk of hospitalization (OR, 3.84, 95% CI: 1.09 - 13.57). "Other studies have shown that people who take narcotics are more likely to visit the emergency department and this may lead to hospitalization," Dr. Wang noted.

"Interestingly," he said, people on antidepressants or benzodiazepines at baseline had no elevated risk for any of the outcomes assessed, and there was some evidence of protection from disease flare. "We know that patients who are depressed or anxious are more likely to have UC symptoms, so these findings suggest that these patients were identified and well managed," said Dr. Wang.

Another interesting observation, he said, is that prebiotic use was associated with increased risk of escalation in UC therapy (OR, 8.63 (95% CI: 1.47 - 50.74). He cautioned that this finding needs further study because the number of patients taking prebiotics was small and the confidence interval was wide.

The study had no commercial funding and the authors have disclosed no relevant conflicts of interest.

SOURCE: http://bit.ly/2McdSHH

American College of Gastroenterology 2018.