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NSAIDs, PPIs, SSRIs increase risk for microscopic colitis

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Exposure to nonsteroidal anti-inflammatory drugs, proton pump inhibitors and selective serotonin reuptake inhibitors were associated with an increased risk for microscopic colitis, which increased with recent and longer use, according to research presented at the 10th Congress of ECCO in Barcelona, Spain.

"Use of PPIs, NSAIDs, and SSRIs is positively associated with microscopic colitis, and it is of relevance to take the recency of use, duration of continuous use, and daily dose into account,” Bas Verhaegh, MD, PhD candidate in gastroenterology at Maastricht University Medical Center in the Netherlands, told Healio Gastroenterology.

Aiming to determine the attributive risk for medication-induced microscopic colitis associated with recent use, longer use or higher doses of NSAIDs, PPIs, SSRIs and statins, Verhaegh and colleagues performed a case-control study of patients diagnosed with microscopic colitis between 1992 and 2013 using the British Clinical Practice Research Datalink. They identified 394 collagenous colitis cases, 292 lymphocytic colitis cases and 525 undefined microscopic colitis cases, and matched each case with up to five matched controls (n = 6,041).

They found that current users of NSAIDs (OR = 1.79; 95% CI, 1.36-2.36), PPIs (OR = 3.93; 95% CI, 2.25-4.74) and SSRIs (OR = 2.27; 95% CI, 1.79-2.89) had increased risk for microscopic colitis compared with past users or those who never used these medications. This association was especially strong with 4 to 12 months of continuous use, but long-term use of more than 2 years attenuated the risk. Exposure to more than 1.25 standardized daily doses was associated with increased risk for microscopic colitis in PPI (OR = 6.9; 95% CI, 3.82-12.49) and SSRI users (OR = 4.15; 95% CI, 2.47-6.97). Current use of NSAIDs (OR = 2.28; 95% CI, 1.46-3.54) and PPIs (OR = 6.15; 95% CI, 4.41-8.58) was associated with increased risk for collagenous colitis specifically, whereas current use of PPIs (OR = 2.4; 95% CI, 1.6-3.59) and SSRIs (OR = 2.65; 95% CI, 1.69-4.15) was associated with increased risk for lymphocytic colitis. Statin use was not found to be associated with risk for microscopic colitis.

“Exposure to PPIs, NSAIDs, and SSRIs should be considered a potential triggering factor for [microscopic colitis] especially in current (last prescription 60-90 days before diagnosis) and recent (last prescription 90-150 days before diagnosis) exposure to these drugs, a continuous use for 4 to 12 months prior to diagnosis, and exposure to high daily dosages,” Verhaegh said. – by Adam Leitenberger

Reference:

Verhaegh BPM, et al. Abstract OP010. Presented at: 10th Congress of ECCO; Feb. 18-21, 2015; Barcelona, Spain.

Disclosure: Verhaegh reports receiving a research grant from Dr. Falk Pharma Benelux B.V. during the conduct of the study. Please see the ECCO website for all other researchers’ relevant financial disclosures.