Use of NSAIDs may not be associated with worsening of inflammatory bowel disease as is generally believed, according to a meta-analysis published in Alimentary Pharmacology & Therapeutics.
“We were surprised to see that there is little data in the literature to support our common recommendation to patients with inflammatory bowel disease to avoid all NSAIDs,” Hamed Khalili, MD, of the digestive health care center at Massachusetts General Hospital, said in a press release.
The researchers identified 13 studies published between 1983 and 2016 that examined NSAID use and IBD exacerbation. They defined their primary outcome as IBD disease activity or complications. To determine heterogeneity of summary estimates (RR) across the studies, investigators also calculated I2 statistics.
The meta-analysis showed the pooled RR for Crohn’s disease exacerbation was 1.42 (95% CI, 0.65-3.09) and I2 was 60.3%. For ulcerative colitis, pooled RR was 1.52 (95% CI, 0.87-2.63) and I2 was 56.1%.
When limiting their analysis to studies with low risk for bias, the investigators found a link between NSAID use and exacerbation of Crohn’s, but not UC.
Additionally, they also found no consistent link between IBD exacerbation and acetaminophen or COX-2 inhibitors, but said further studies are needed.
“Our meta-analysis confirms the need for larger well-designed studies examining the relationship between acetaminophen and NSAIDs, and disease activity among patients with established IBD,” the researchers wrote. – by Alex Young
Khalili reports no relevant financial disclosures. Please see the full study for all author’s relevant disclosures.