HONOLULU — The use of prescription NSAIDs did not promote flares of inflammatory bowel disease in a large observational study, Dr. Faten N. Aberra reported at the annual meeting of the American College of Gastroenterology.
This has been a controversial issue, as previous studies have yielded conflicting results. But those studies were uncontrolled and/or small in size, said Dr. Aberra of the University of Pennsylvania, Philadelphia.
She used data from the U.K. General Practice Research Database for the years 1988–1997 to conduct a matched, case-crossover study in which patients were their own controls. Dr. Aberra identified 1,205 patients with Crohn's disease who experienced a collective 2,622 flares requiring treatment after at least a 4-month period of remission, and 2,029 ulcerative colitis patients with 5,227 flares during 4 years of follow-up.
An NSAID was prescribed within the 60 days prior to 3.9% of the ulcerative colitis flares and 5.1% of the Crohn's disease flares. The adjusted odds ratio for exposure to a prescription NSAID within 60 days before a Crohn's disease flare was 0.85, and for an ulcerative colitis flare was 1.18, with neither being statistically significant.
Exposures to NSAIDs within 15, 30, and 45 days yielded similar results, as did prescription NSAID exposures 2–4 months before a disease flare.
The results of this study don't rule out the possibility that a small percentage of patients with inflammatory bowel disease are especially sensitive to NSAIDS, but the findings do indicate that most patients in remission can tolerate the drugs without raising their risk of a flare, Dr. Aberra said.
Audience members questioned the validity of the study results, given that the U.K. database didn't include any information on over-the-counter NSAIDs. Dr. Aberra replied that over-the-counter NSAIDs are taken in lower doses and for shorter durations than are prescription regimens, so if prescription NSAIDs weren't associated with inflammatory bowel disease flares, it's unlikely that over-the-counter NSAIDs would be.