Division of Gastroenterology and Hepatology, University of Michigan Medicine, Ann Arbor, Michigan, USA.
VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
Am J Gastroenterol. 2022 Nov 1;117(11):1851-1857. doi: 10.14309/ajg.0000000000001932. Epub 2022 Aug 12.
Studies suggest that nonsteroidal anti-inflammatory drugs (NSAID) may contribute to inflammatory bowel disease (IBD) exacerbations. We examined whether variation in the likelihood of IBD exacerbations is attributable to NSAID.
In a cohort of patients with IBD (2004-2015), we used 3 analytic methods to examine the likelihood of an exacerbation after an NSAID exposure. First, we matched patients by propensity for NSAID use and examined the association between NSAID exposure and IBD exacerbation using an adjusted Cox proportional hazards model. To assess for residual confounding, we estimated a previous event rate ratio and used a self-controlled case series analysis to further explore the relationship between NSAID and IBD exacerbations.
We identified 15,705 (44.8%) and 19,326 (55.2%) IBD patients with and without an NSAID exposure, respectively. Findings from the Cox proportional hazards model suggested an association between NSAID and IBD exacerbation (hazard ratio 1.24; 95% confidence interval 1.16-1.33). However, the likelihood of an IBD exacerbation in the NSAID-exposed arm preceding NSAID exposure was similar (hazard ratio 1.30; 95% confidence interval 1.21-1.39). A self-controlled case series analysis of 3,968 patients who had both an NSAID exposure and IBD exacerbation demonstrated similar exacerbation rates in the 1 year preceding exposure, 2-6 weeks postexposure, and 6 weeks to 6 months postexposure, but a higher incidence in 0-2 weeks postexposure, suggesting potential confounding by reverse causality.
While we see an association between NSAID and IBD exacerbations using traditional methods, further analysis suggests this may be secondary to residual bias. These findings may reassure patients and clinicians considering NSAID as a nonopioid pain management option.
研究表明，非甾体抗炎药（NSAID）可能导致炎症性肠病（IBD）恶化。我们研究了 IBD 恶化的可能性是否归因于 NSAID。
在 IBD 患者队列中（2004-2015 年），我们使用 3 种分析方法来检查 NSAID 暴露后恶化的可能性。首先，我们通过 NSAID 使用倾向对患者进行匹配，并使用调整后的 Cox 比例风险模型检查 NSAID 暴露与 IBD 恶化之间的关联。为了评估残余混杂因素，我们估计了先前事件发生率比，并使用自身对照病例系列分析进一步探讨 NSAID 与 IBD 恶化之间的关系。
我们分别确定了 15705（44.8%）和 19326（55.2%）例有和无 NSAID 暴露的 IBD 患者。Cox 比例风险模型的结果表明 NSAID 与 IBD 恶化之间存在关联（风险比 1.24；95%置信区间 1.16-1.33）。然而，在 NSAID 暴露之前，NSAID 暴露臂中 IBD 恶化的可能性相似（风险比 1.30；95%置信区间 1.21-1.39）。对 3968 例同时有 NSAID 暴露和 IBD 恶化的患者进行的自身对照病例系列分析显示，在暴露前 1 年、暴露后 2-6 周和暴露后 6 周到 6 个月的恶化率相似，但在暴露后 0-2 周的发生率较高，表明可能存在反向因果关系的混杂。
虽然我们使用传统方法观察到 NSAID 与 IBD 恶化之间存在关联，但进一步的分析表明，这可能是残留偏差的结果。这些发现可能会使考虑 NSAID 作为非阿片类疼痛管理选择的患者和临床医生感到安心。
