Colon

63 - Non-Steroidal Anti-Inflammatory Drugs and Aspirin, but Not Acetaminophen, Are Associated With an Increased Risk of Microscopic Colitis: Results From the Nurses' Health Studies

Wednesday, October 10
9:50 AM - 10:00 AM
Location: Terrace Ballroom 4 (level 400)

Category: Colon
Kristin E. Burke, MD, MPH1, Po-Hong Liu, MD, MPH2, Ashwin Ananthakrishnan, MD, MPH1, Paul Lochhead, MBChB, PhD1, Ola Olen, MD, PhD3, Jonas Ludvigsson, MD, PhD3, James Richter, MD1, Andrew Chan, MD, MPH1, Hamed Khalili, MD, MPH1
1Massachusetts General Hospital, Boston, MA; 2Massachusetts General Hospital, Dallas, TX; 3Karolinska Institutet, Stockholm, Stockholms Lan, Sweden

Introduction: Use of non-steroidal anti-inflammatory drugs (NSAIDs) has been consistently linked to microscopic colitis. However, the influence of other common analgesics typically used for the same clinical indications, such as aspirin and acetaminophen, has not been extensively studied.

Methods: We conducted a prospective cohort study of 167,100 women enrolled in the Nurses’ Health Study (NHS) and NHSII without microscopic colitis at baseline.  Use of NSAIDs, aspirin, and acetaminophen were collected at baseline in 1990 in NHS and 1991 in NHSII and updated biennially.  Cases of microscopic colitis were confirmed through pathology record review.  We used Cox proportional hazards modeling with time-varying covariates to estimate hazard ratios (HR) and 95% confidence intervals (CI) for development of microscopic colitis.

Results: Through 2015, we confirmed 269 cases of microscopic colitis over 4,172,024 person-years of follow-up.  Compared to never use, current regular use of NSAIDs (multivariable-adjusted HR 2.66; 95% CI 1.76 – 4.01) and daily aspirin use (multivariable-adjusted HR 2.09; 95% CI 1.36 – 3.22) were associated with increased risk of microscopic colitis. The risk increased with longer cumulative duration of use (p-trend < 0.0001 for NSAID use, p-trend = 0.007 for aspirin use). In sensitivity analyses, the associations between use of NSAIDs or aspirin and risk of microscopic colitis remained consistent after adjusting for proton pump inhibitor and selective serotonin reuptake inhibitor use (p = 0.001 for NSAID use, p = 0.041 for aspirin use). Additionally, limiting analyses to women without autoimmune or cardiovascular disease did not materially alter our estimates. In contrast, we did not observe an association between current acetaminophen use and risk of microscopic colitis (multivariable-adjusted HR 1.27; 95% CI 0.92 – 1.76).

Discussion: Use of NSAIDs and aspirin, but not acetaminophen, is associated with increased risk of microscopic colitis. These findings may shed light on potential mechanisms by which these medications increase the risk of microscopic colitis.

Table 1
Table 2
Table 3

Disclosures:
Kristin Burke indicated no relevant financial relationships.
Po-Hong Liu indicated no relevant financial relationships.
Ashwin Ananthakrishnan indicated no relevant financial relationships.
Paul Lochhead indicated no relevant financial relationships.
Ola Olen indicated no relevant financial relationships.
Jonas Ludvigsson indicated no relevant financial relationships.
James Richter indicated no relevant financial relationships.
Andrew Chan: Bayer Healthcare – Consultant.
Hamed Khalili indicated no relevant financial relationships.

Kristin E. Burke

Gastroenterology Fellow
Massachusetts General Hospital
Boston, Massachusetts

Presentation(s):

Send Email for Kristin Burke


Assets

63 - Non-Steroidal Anti-Inflammatory Drugs and Aspirin, but Not Acetaminophen, Are Associated With an Increased Risk of Microscopic Colitis: Results From the Nurses' Health Studies



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Non-Steroidal Anti-Inflammatory Drugs and Aspirin, but Not Acetaminophen, Are Associated With an Increased Risk of Microscopic Colitis: Results From the Nurses' Health Studies