Do Patients With IBD Continue Using Pain Medication After Starting Advanced Therapy?

Patients newly diagnosed with Crohn disease or ulcerative colitis continue using pain medications, such as opioids and NSAIDS, after initiating advanced treatment.

While initiation of advanced therapies reduce intake of NSAIDs, glucocorticoids, and opioids, many patients with newly diagnosed Crohn disease (CD) or ulcerative colitis (UC) still require concurrent pain medications along with advanced therapies and even increased intake in neuromodulators, according to study findings published in BMC Gastroenterology.

Researchers conducted a retrospective, observational cohort study to analyze trends in pain medication usage 12 months before and after initiation of advanced therapies in adults with newly diagnosed CD (n=540) and  UC (n=373).

Advanced therapies approved by the United States Food and Drug Administration (FDA) for patients with CD included natalizumab, certolizumab pegol, adalimumab, infliximab, vedolizumab, and ustekinumab. FDA-approved advanced therapies for patients with UC included adalimumab, infliximab, golimumab, vedolizumab, tofacitinib, and ustekinumab.

Pain medications included nonsteroidal antiinflammatory drugs (NSAIDs), glucocorticoid steroids, non-narcotic analgesics, opioids, and neuromodulators, such as antidepressants, anticonvulsants, and muscle relaxants.

These findings are clinically relevant because they suggest the complexity of IBD pain management.

In the 12 months before advanced therapy initiation, 23.1% of patients with CD took NSAIDs, 78.1% glucocorticoids, 49.4% opioids, and 29.3% neuromodulators. Comparably, 20.9% of patients with UC took NSAIDs, 91.4% glucocorticoids, 40.8% opioids, and 29.5% neuromodulators.

After 12 months, initiation of advanced therapies significantly reduced glucocorticoid use in patients both with CD (78.1% to 58.9%; P <.001) and UC (91.4% to 74.3%; P <.001). Similarly, use of opioids also decreased significantly from 49.4% to 41.5% in patients with CD (P =.004) and insignificantly from 40.8% to 36.5% in patients with UC (P =.194). Prescription-based NSAID use also decreased significantly in patients with CD (23.1% to 15.0%; P <.001) and UC (20.9% to 15.8%; P =.035).

In contrast, neuromodulator use significantly increased following initiation of advanced therapies in both patients with CD (29.3% to 33.7%; P =.007) and UC (29.5% to 35.7%; P =.006).

“Use of pain medications such as NSAIDs, glucocorticoids, opioids, and neuromodulators is common among patients with CD or UC,” the study authors noted. “Additionally, the results highlight that those patients with CD or UC continued to receive pain medications even after initiating advanced therapies. These findings are clinically relevant because they suggest the complexity of IBD pain management.”

Study limitations include use of pain medications for active conditions other than CD or UC, lack of assessment of over-the-counter pain medication usage, errors in recording diagnosis codes, relatively short follow-up period of 12 months, and lack of generalizability to populations outside of the US or to uninsured patients within the US.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Hunter T, Naegeli AN, Nguyen C, et al. Medication use among patients with Crohn’s disease or ulcerative colitis before and after the initiation of advanced therapy. BMC Gastroenterol. 2022;22(1):474. doi:10.1186/s12876-022-02584-4