Polypharmacy is a risk factor for disease flare in adult patients with ulcerative colitis: a retrospective cohort study

다국어 초록 (Multilingual Abstract)

Background/Aims: Polypharmacy is a common clinical problem with chronic diseases that can be associated with adverse patient outcomes. The present study aimed to determine the prevalence and patient-specific characteristics associated with polypharmacy in an ulcerative colitis (UC) population and to assess the impact of polypharmacy on disease outcomes. Methods: A retrospective chart review of patients with UC who visited a tertiary medical center outpatient clinic between 2006 and 2011 was performed. Polypharmacy was defined as major (≥5 non-UC medications) or minor (2–4 non-UC medications). UC medications were excluded in the polypharmacy grouping to minimize the confounding between disease severity and polypharmacy. Outcomes of interest include disease flare, therapy escalation, UC-related hospitalization, and surgery within 5 years of the initial visit. Results: A total of 457 patients with UC were eligible for baseline analysis. Major polypharmacy was identified in 29.8% of patients, and minor polypharmacy was identified in 40.9% of the population. Polypharmacy at baseline was associated with advanced age (P<0.001), female sex (P=0.019), functional gastrointestinal (GI) disorders (P<0.001), and psychiatric disease (P<0.001). Over 5 years of follow-up, 265 patients remained eligible for analysis. After adjusting for age, sex, functional GI disorders, and psychiatric disease, major polypharmacy was found to be significantly associated with an increased risk of disease flare (odds ratio, 4.00; 95% confidence interval, 1.66–9.62). However, major polypharmacy was not associated with the risk of therapy escalation, hospitalization, or surgery. Conclusions: Polypharmacy from non-inflammatory bowel disease medications was present in a substantial proportion of adult patients with UC and was associated with an increased risk of disease flare.

참고문헌 (Reference)

1 Longobardi T, "Work losses related to inflammatory bowel disease in the United States : results from the National Health Interview Survey" 98 : 1064-1072, 2003

2 Narula N, "Trends in narcotic and corticosteroid prescriptions in patients with inflammatory bowel disease in the United States ambulatory care setting from 2003 to 2011" 23 : 868-874, 2017

3 Bonner GF, "Tolerance of nonsteroidal antiinflammatory drugs in patients with inflammatory bowel disease" 95 : 1946-1948, 2000

4 Bernstein CN, "The clustering of other chronic inflammatory diseases in inflammatory bowel disease : a population-based study" 129 : 827-836, 2005

5 Buckley JP, "The burden of comedication among patients with inflammatory bowel disease" 19 : 2725-2736, 2013

6 Sandborn WJ, "Safety of celecoxib in patients with ulcerative colitis in remission : a randomized, placebo-controlled, pilot study" 4 : 203-211, 2006

7 Miao XP, "Role of selective cyclooxygenase-2 inhibitors in exacerbation of inflammatory bowel disease : a systematic review and meta-analysis" 69 : 181-191, 2008

8 Ha C, "Risk of arterial thrombotic events in inflammatory bowel disease" 104 : 1445-1451, 2009

9 Meyer AM, "Relapse of inflammatory bowel disease associated with use of nonsteroidal anti-inflammatory drugs" 51 : 168-172, 2006

10 Byrne G, "Prevalence of anxiety and depression in patients with inflammatory bowel disease" 2017 : 6496727-, 2017

11 Takeuchi K, "Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease" 4 : 196-202, 2006

12 Nugent Z, "Predictors of emergency department use by persons with inflammatory bowel diseases : a population-based study" 22 : 2907-2916, 2016

13 Vetrano DL, "Poor adherence to chronic obstructive pulmonary disease medications in primary care : role of age, disease burden and polypharmacy" 17 : 2500-2506, 2017

14 Bjerrum L, "Polypharmacy: correlations with sex, age and drug regimen. A prescription database study" 54 : 197-202, 1998

15 Sergi G, "Polypharmacy in the elderly : can comprehensive geriatric assessment reduce inappropriate medication use" 28 : 509-518, 2011

16 Hajjar ER, "Polypharmacy in elderly patients" 5 : 345-351, 2007

17 Cross RK, "Polypharmacy and Crohn’s disease" 21 : 1211-1216, 2005

18 Viktil KK, "Polypharmacy among patients admitted to hospital with rheumatic diseases" 23 : 153-158, 2001

19 DeSevo G, "Pharmacologic issues in management of chronic disease" 39 : 345-362, 2012

20 Evans JM, "Non-steroidal anti-inflammatory drugs are associated with emergency admission to hospital for colitis due to inflammatory bowel disease" 40 : 619-622, 1997

21 Cross RK, "Narcotic use in patients with Crohn’s disease" 100 : 2225-2229, 2005

22 Ham M, "Mesalamine in the treatment and maintenance of remission of ulcerative colitis" 5 : 113-123, 2012

23 Mehat P, "Medication nonadherence in systemic lupus erythematosus: a systematic review" 69 : 1706-1713, 2017

24 Ha CY, "Medical management of inflammatory bowel disease in the elderly : balancing safety and efficacy" 30 : 67-78, 2014

25 Kim S, "Measuring medication adherence in older community-dwelling patients with multimorbidity" 74 : 357-364, 2018

26 Navabi S, "Influences and impact of anxiety and depression in the setting of inflammatory bowel disease" 24 : 2303-2308, 2018

27 Abraham C, "Inflammatory bowel disease" 361 : 2066-2078, 2009

28 Terzić J, "Inflammation and colon cancer" 138 : 2101-2114, 2010

29 Loftus EV Jr, "Increased risks of developing anxiety and depression in young patients with Crohn’s disease" 106 : 1670-1677, 2011

30 Haapamäki J, "Increased risk for coronary heart disease, asthma, and connective tissue diseases in inflammatory bowel disease" 5 : 41-47, 2011

31 Gurwitz JH, "Incidence and preventability of adverse drug events among older persons in the ambulatory setting" 289 : 1107-1116, 2003

32 Juneja M, "Geriatric inflammatory bowel disease : phenotypic presentation, treatment patterns, nutritional status, outcomes, and comorbidity" 57 : 2408-2415, 2012

33 Hovstadius B, "Factors leading to excessive polypharmacy" 28 : 159-172, 2012

34 Maier L, "Extensive impact of non-antibiotic drugs on human gut bacteria" 555 : 623-628, 2018

35 Bonner GF, "Exacerbation of inflammatory bowel disease associated with use of celecoxib" 96 : 1306-1308, 2001

36 Ananthakrishnan AN, "Epidemiology and risk factors for IBD" 12 : 205-217, 2015

37 Hueber W, "Effects of AIN457, a fully human antibody to interleukin-17A, on psoriasis, rheumatoid arthritis, and uveitis" 2 : 52-, 2010

38 Irving PM, "Drug interactions in inflammatory bowel disease" 103 : 207-219, 2008

39 Wahed M, "Does psychological counseling alter the natural history of inflammatory bowel disease" 16 : 664-669, 2010

40 Goodhand JR, "Do antidepressants influence the disease course in inflammatory bowel disease? A retrospective case-matched observational study" 18 : 1232-1239, 2012

41 Click B, "Demographic and clinical predictors of high healthcare use in patients with inflammatory bowel disease" 22 : 1442-1449, 2016

42 Hanson KA, "Clinical features and outcome of patients with inflammatory bowel disease who use narcotics : a case-control study" 15 : 772-777, 2009

43 Perry BA, "A prediction model for polypharmacy : are older, educated women more susceptible to an adverse drug event" 13 : 39-51, 2001

44 Graff LA, "A population-based study of fatigue and sleep difficulties in inflammatory bowel disease" 17 : 1882-1889, 2011

45 Bonner GF, "A long-term cohort study of nonsteroidal anti-inflammatory drug use and disease activity in outpatients with inflammatory bowel disease" 10 : 751-757, 2004