TOPLINE:

Among patients with inflammatory bowel disease (IBD), prescription nonsteroidal anti-inflammatory drug (NSAID) use doesn’t increase hospitalization risk in ulcerative colitis but shows a small increase in Crohn’s disease.

METHODOLOGY:

• NSAIDs are widely prescribed for musculoskeletal symptoms because of their effectiveness, low cost, and accessibility; however, concerns persist that they may trigger disease flares in patients with IBD.
• Researchers conducted a retrospective cohort study using a large commercial claims database (January 2000-June 2022) to evaluate the association between prescription NSAID use and severe IBD flares requiring hospitalization.
• The primary outcome was IBD-related hospitalization, defined as an inpatient stay lasting > 1 day; when comparing the use of NSAIDs with nonuse, noninferiority was defined as a 95% CI not exceeding 1.20, a threshold considered clinically acceptable.
• Patients were followed from the first NSAID fill until the earliest IBD-related hospitalization, loss of continuous health plan enrollment, study end, or discontinuation of NSAID exposure.

TAKEAWAY:

• Among 348,095 patients with IBD, 80,710 (mean age, 52.2 years; 59.5% female; median follow-up, 0.6 years) had a new NSAID prescription fill and were matched with 190,526 patients without NSAID exposure (mean age, 52.2 years; 56.9% female; median follow-up, 1.2 years).
• NSAID exposure was associated with an increased risk for IBD-related hospitalization among all patients (hazard ratio [HR], 1.07; 95% CI, 1.04-1.10), but the upper limit of the CI remained below the noninferiority margin.
• Among patients with ulcerative colitis, NSAID exposure was not associated with an increased risk for IBD-related hospitalization (HR, 0.97; 95% CI, 0.93-1.02), meeting noninferiority criteria.
• Among patients with Crohn’s disease, NSAID use was associated with a small but clinically acceptable increase in IBD-related hospitalization risk (HR, 1.16; 95% CI, 1.12-1.21), and noninferiority was not established.
• NSAID exposure was also associated with increased risks for all-cause hospitalization and gastrointestinal surgery across the cohort.

IN PRACTICE:

“These results suggest that NSAID use may be acceptable for select patients with IBD who have significant musculoskeletal symptoms, especially those with ulcerative colitis,” the authors of the study wrote.

SOURCE:

The study was led by Adam S. Mayer, MD, MSCE, Center for Discovery and Innovation, Hackensack Meridian Health, Hackensack, New Jersey. It was published online in Arthritis Care & Research.

LIMITATIONS:

Over-the-counter NSAID use was not captured, potentially leading to exposure misclassification. Residual unmeasured confounding factors, such as smoking status and disease activity, were not reliably captured. The study focused on severe flares requiring hospitalizations and did not capture milder disease exacerbations.

DISCLOSURES:

The study received support from the National Institutes of Health, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.