IBD Associated With Increased Prescription Medication Use 10 Years Before Diagnosis

Patients with inflammatory bowel disease (IBD) have an increased use of prescription medications 10 years before IBD diagnosis, according to study results published in the American Journal of Gastroenterology.

The observational study assessed patterns of prescription medication use by identifying patients with incident IBD in Denmark in 2005 to 2018 from several Danish databases. The patients were matched 1:10 to individuals without IBD for age, sex, municipality of residence, and quarter of year of IBD diagnosis. Patients’ prescription histories were compared for each year of the preceding 10 years.

The patients with IBD were aged 18 years and older and lived in Denmark 10 years before IBD diagnosis. The control individuals were aged 18 years and older and lived in Denmark 10 years before the matching date.

Medication users had at least 1 redeemed drug prescription, and prescriptions were categorized based on World Health Organization classification.

A total of 29,219 patients with IBD and 292,190 matched individuals were included. The participants had a median age at IBD diagnosis/matching date of 43 (IQR, 29-60) years, 53.5% were women, 30.0% had Crohn disease (CD), and 67.0% had ulcerative colitis (UC).

During the 10th year before IBD diagnosis/matching, patients with IBD had more medication users vs the matched population in 12 of 14 main medication groups (P <.0001). The greatest difference in users between the 2 groups was for IBD-related medications, including medications used to treat immunologic diseases (1.8 times more users vs the matched population) and gastrointestinal (GI) conditions (1.4 times more users vs the matched population).

The IBD group had a steep increase 2 years prediagnosis in medication use for GI and metabolic diseases as well as for cardiovascular, endocrinologic, infectious, neoplastic and immunologic, and parasitic diseases. Patients with CD had more users vs the UC group in most of the main medication groups. More women were users, compared with men regardless of IBD status, and the IBD group had greater medication use, compared with the matched population in all age groups.

The IBD group had a greater use of medications for most organ systems, compared with the matched population at the 10th year prediagnosis. Among patients with CD, IBD-related medications had the largest statistically significant difference in medication users, with 2.7 times more users in the CD group vs the matched population. Medications for intestinal infection and inflammation had 2.6 times more users in the CD population vs the matched population. In addition, medications for blood disorders, cardiovascular disease, some infections, respiratory diseases, nervous system disorders, and some sensory conditions had 1.1 to 1.8 times more users in the CD population, compared with the matched population. Patients with UC also had more medication users vs the matched population, although the effect sizes were generally lower.

Among several limitations, over-the-counter drugs or drugs administered during hospitalization were not evaluated, confounding is possible, and risk factors of IBD such as familial history of IBD or tobacco smoking were not adjusted for.

“Collectively, our findings further suggest that IBD, and especially CD, could be a multiorgan disease to a much larger extent than hitherto established,” study authors noted. “The long prediagnostic period represents a window of opportunity for earlier detection and intervention as well as toward prediction and prevention strategies of IBD.”

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