Receipt of antibiotics, hormonal medications, and oral contraceptives and long-term receipt of nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with increased odds of incident inflammatory bowel disease (IBD), according to study findings published in Clinical Gastroenterology and Hepatology.
Researchers conducted the Prospective Urban Rural Epidemiology (PURE) study to measure the association between medication use and IBD risk. The first and second phases of PURE were conducted from January 1, 2003, through December 31, 2016, in 24 countries and included 133,137 participants aged 20 to 80 years with available data from at least 1 follow-up. Standardized questionnaires were used to obtain participant data at baseline and during follow-up visits that occurred at least every 3 years. The current analysis included all outcome events up to April 2, 2021.
A total of 86,173 participants had 2 or 3 follow-up visits (64.7%). After a median follow-up of 11.0 years (IQR, 9.2-12.2), 571 individuals had a recorded diagnosis of IBD, including 143 with Crohn disease (CD) and 428 with ulcerative colitis (UC). The cohort had a mean age of 50.3 years (SD, 9.7), and 59.5% were women.
A total of 947 (0.7%) participants reported received antibiotics at baseline, of whom 16 developed IBD. Baseline antibiotic receipt was significantly associated with IBD after minimal adjustment (odds ratio [OR], 3.10; 95% CI, 1.88-5.14; P <.001). This finding remained significant after further adjustment for additional covariates (adjusted odds ratio [aOR], 2.81; 95% CI, 1.67-4.73; P =.0001).
Among the 24,610 (31.1%) women who reported previous or current oral contraceptive receipt at baseline, 185 developed IBD. Previous or current oral contraceptive receipt at baseline was significantly associated with IBD after minimal adjustment (OR, 2.40; 95% CI, 1.90-3.04; P <.001), which remained significant after further adjustment (aOR, 2.17; 95% CI, 1.70-2.77; P <.001).
There were 405 patients (0.3%) with baseline hormonal medication receipt had an increased likelihood of IBD vs those who did not receive hormonal medications, after minimal adjustment (OR, 4.81; 95% CI, 1.97-11.77; P =.001), which remained significant after further adjustment (aOR, 4.43; 95% CI, 1.78-11.01; P =.001).
A total of 2939 (2.2%) participants reported receiving NSAIDs at baseline, and 29 developed IBD. Baseline NSAID receipt was significantly associated with IBD (OR, 1.81; 95% CI, 1.24-2.65; P =.002), which remained significant after adjustment for additional covariates (aOR, 1.80; 95% CI, 1.23-2.64; P =.002).
Patients who had long-term NSAID receipt, defined as use at baseline and at follow-up, had a greater likelihood of IBD after full adjustment for covariates (aOR, 5.58; 95% CI, 2.26-13.80; P <.001).
Limitations of the study include the lack of generalizability to younger individuals, the lack of data available regarding dose and duration at study enrollment, and the self-reporting of all medication use.
“This study illuminates the importance of caution in prescribing antibiotics and oral contraceptives, and if appropriate, discouraging patients from long-term use of NSAIDs to mitigate this established environmental risk of IBD,” conclude the researchers.
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Narula N, Wong ECL, Pray C, et al. Associations of antibiotics, hormonal therapies, oral contraceptives, and long-term NSAIDs with inflammatory bowel disease: results from the Prospective Urban Rural Epidemiology (PURE) study. Clin Gastroenterol Hepatol. Published online December 14, 2022. doi:10.1016/j.cgh.2022.11.037