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Systematic review with meta-analysis: association between acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of Crohn's disease and ulcerative colitis exacerbation.

ABSTRACT: BACKGROUND:Unlike acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) have generally been thought to be associated with increased risk of IBD exacerbation. AIM:To carry out a systematic review and meta-analysis of previous studies examining the association between acetaminophen and NSAIDs including cyclooxygenase (COX-2) inhibitors use, and risk of Crohn's disease (CD) and ulcerative colitis (UC) exacerbation. METHODS:We identified published manuscripts and abstracts through 1 March 2017 by systematic search of Medline, Embase, Cochrane and other trial registries. Quality assessment was done using Newcastle-Ottawa scale and random-effect meta-analysis using pooled relative risks (RRs) and 95% CIs were calculated. RESULTS:Eighteen publications between years 1983 and 2016 were identified. For the meta-analysis, pooled RRs of disease exacerbation with NSAIDs use were (1.42, 95% CI, 0.65-3.09), I2 = 60.3% for CD, and (1.52, 95% CI, 0.87-2.63), I2 = 56.1% for UC. The corresponding values for acetaminophen use were (1.40, 95% CI, 0.96-2.04), I2 = 45.6% for UC, and (1.56, 95% CI, 1.22-1.99), I2 = 0.0% for IBD. Sensitivity analyses limited to studies with low risk of bias showed a significantly increased risk of CD exacerbation (1.53, 95% CI, 1.08-2.16) but not UC (0.94, 95% CI, 0.36-2.42) with NSAIDs use. CONCLUSIONS:Contrary to generally accepted belief, we did not find a consistent association between NSAIDs use and risk of CD and UC exacerbation. There was also no consistent evidence for association with acetaminophen although further studies are needed.

SUBMITTER: Moninuola OO

PROVIDER: S-EPMC5992031 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Systematic review with meta-analysis: association between acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of Crohn's disease and ulcerative colitis exacerbation.

Moninuola O O OO Milligan W W Lochhead P P Khalili H H

Alimentary pharmacology & therapeutics 20180405 11

<h4>Background</h4>Unlike acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) have generally been thought to be associated with increased risk of IBD exacerbation.<h4>Aim</h4>To carry out a systematic review and meta-analysis of previous studies examining the association between acetaminophen and NSAIDs including cyclooxygenase (COX-2) inhibitors use, and risk of Crohn's disease (CD) and ulcerative colitis (UC) exacerbation.<h4>Methods</h4>We identified published manuscripts and abstrac ...[more]

PMID: 29620794

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Project description:ObjectivesPotentially harmful nonsteroidal anti-inflammatory drugs (NSAIDs) utilization persists at undesirable rates throughout the world. The purpose of this paper is to review the literature on interventions to de-implement potentially harmful NSAIDs in healthcare settings and to suggest directions for future research.DesignScoping review.Data sourcesPubMed, CINAHL, Embase, Cochrane Central, and Google Scholar (2000-2022).Study selectionStudies reporting on the effectiveness of interventions to systematically reduce potentially harmful NSAID utilization in healthcare settings.Data extractionUsing Covidence systematic review software, we extracted study and intervention characteristics, including the effectiveness of interventions in reducing NSAID utilization.ResultsFrom 7,818 articles initially identified, 68 were included in the review. Most studies took place in European countries (45.6%) or the U.S. (35.3%), with randomized controlled trial as the most common design (55.9%). The majority of studies (76.2%) reported a reduction in the utilization of potentially harmful NSAIDs. Interventions were largely clinician-facing (76.2%) and delivered in primary care (60.2%). Academic detailing, clinical decision support or electronic medical record interventions, performance reports, and pharmacist review were frequent approaches employed. NSAID use was most commonly classified as potentially harmful based on patients' age (55.8%) or history of gastrointestinal disorders (47.1%) or kidney disease (38.2%). Only 7.4% of interventions focused on over-the-counter NSAIDs in addition to prescription. Few studies (5.9%) evaluated pain or quality of life following NSAIDs discontinuation.ConclusionMany varied interventions are effective in de-implementing potentially harmful NSAIDs in healthcare settings. Efforts to adapt, scale, and disseminate these interventions are needed. In addition, future interventions should address over-the-counter NSAIDs, which are broadly available and widely used. Evaluating unintended consequences of interventions, including patient-focused outcomes, is another important priority. What is already known on this topic - NSAIDs are overutilized by high-risk patients at persistent rates. Interventions to reduce potentially harmful NSAIDs prescribing and over-the-counter (OTC) NSAIDs use are needed . What this study adds - More than 50 studies published internationally from 2000 to 2022 (three quarters of those reviewed) reported on interventions effective in de-implementing potentially harmful NSAIDs. We extracted and summarized characteristics of studies and of interventions to identify research gaps and priorities for future research . How this study might affect research, practice or policy - In light of the large number of effective interventions on record, implementation and dissemination efforts should be the priority of future work .

Dataset Information

Systematic review with meta-analysis: association between acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of Crohn's disease and ulcerative colitis exacerbation.

Publications

Systematic review with meta-analysis: association between acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of Crohn's disease and ulcerative colitis exacerbation.

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