From the Journals

Mixed outcomes in analysis of NSAIDs and IBD exacerbation


Key clinical point: Nonsteroidal anti-inflammatory drugs may increase the risk of some inflammatory bowel diseases.

Major finding: NSAIDs are associated with a 42% increased risk of Crohn’s disease exacerbation.

Study details: Systematic review and meta-analysis of 18 studies.

Disclosures: One author was supported by the American Gastroenterological Association and by the National Institute of Diabetes and Digestive and Kidney Diseases, and declared consulting and research funding from the pharmaceutical industry. No other conflicts of interest were declared.

Source: Moninuola O et al. Aliment Pharmacol Ther. 2018 Apr 5. doi: 10.1111/apt.14606.



The relationship between nonsteroidal anti-inflammatory drug (NSAID) use and exacerbations of inflammatory bowel disease (IBD) may not be as clear-cut as previously thought, according to the results of a systematic review and meta-analysis.

The report was published online in Alimentary Pharmacology and Therapeutics.

The researchers presented their analysis of 18 studies examining the association between acetaminophen, NSAIDs, and cyclo-oxygenase-2 (COX-2) inhibitors, and the risk of Crohn’s disease, ulcerative colitis flares, and IBD.

Five studies looked at the association between NSAIDS – such as naproxen and indomethacin – and the risk of Crohn’s disease exacerbation. While this showed a 42% increased risk of exacerbation with NSAID use, the authors noted that they saw substantial heterogeneity across the studies.

For example, two nonrandomized trials comparing NSAIDs and acetaminophen in patients with quiescent disease found NSAIDs were associated with frequent, early clinical relapse of IBD. But another study comparing patients with symptom flares and those in clinical remission found no difference between the two groups in the frequency of NSAID use.

Empty pill bottles and pills ©PhotoDisk
Eight articles in the review looked specifically at COX-2 inhibitor use and the impact on IBD, although they were not included in the meta-analysis because of insufficient data. Among these studies, a randomized, double-blind placebo-controlled trial in 222 patients found no association between the use of celecoxib and the risk of disease exacerbation, while two retrospective cohort studies found a high rate of IBD exacerbations in patients taking celecoxib or rofecoxib.

Researchers also conducted a meta-analysis of studies involving acetaminophen, which found a statistically significant 56% increase in the risk of IBD exacerbation with acetaminophen. However, in the systematic review, there were two nonrandomized clinical trials which showed only one disease exacerbation in 46 patients with quiescent IBD, which was lower than the rate seen in the NSAID group.

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