S3198 Antidepressant Use Is Associated With Poor Clinical Outcomes in the Setting of Inflammatory Bowel Disease

Abstract

INTRODUCTION: Antidepressant medications (AMs) are frequently used in inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). Many AMs are designed to enhance serotonin (5-HT) signaling. Increased 5-HT availability is associated with inflammation in animal models and human studies of IBD. We hypothesized that use of 5-HT-enhancing AMs would be associated with poor clinical outcomes in IBD. METHODS: We performed a retrospective cohort study using the Truven Health Marketscan® commercial claims database between 1/1/06 and 12/31/12. Participants (18–64 years) had at least 2 appropriate ICD-9 diagnoses for IBD, concurrent use of IBD medications, no other auto-inflammatory disease, at least 1 year of continuous enrollment before index diagnosis and 2 years after, during the study period. We identified new prescriptions of AM (includingselective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic, tetracyclics, monoamine oxidase inhibitors and other varieties) using the medication possession ratio (MPR; 80% adherence).Primary outcomes were: corticosteroid use, IBD-related complication (intestinal stricture and/or fistula), hospitalization, emergency room (ER) visit, IBD-related surgery and death within 2 years of IBD diagnosis or starting AM. We performed descriptive statisticsand calculatedadjusted hazard ratios (aHRs) comparing 2 groups (AM use vs. no AM use) for each of the outcomes above (adjusting for age, sex, comorbidity, IBD medication use and clinic visits). We also performed subgroup analyses considering IBD and AM subtype. RESULTS: 117,255 people had IBD (51.3% male; 55.6% UC). 7.1% used at least one AM during the follow-up period [most often a SSRI (4.9%) and/or SNRI (1.1%)]. AM users were younger, more likely female and to have several comorbidities, and used IBD-targeted medications more often (Table 1). Corticosteroid use, hospitalizations, ER visits and death were independently associated with AM use (Table 2).In the UC cohort, AM users were more likely to have complications [aHR = 1.90 (1.42–2.54), P < 0.0001)]. SSRIs were the only group independently associated with death [aHR = 7.93 (3.62–17.36), P < 0.0001]. CONCLUSION: We demonstrated that AM use is independently associated with an increased risk of many poor outcomes in IBD (including death). While further study is warranted, providers should exercise caution when using AM in IBD, particularly SSRIs.Table 1.: Demographic and Clinical Characteristics of Antidepressant Medication Users and Non-Users. AM = antidepressant medication; SD = standard deviation.Table 2.: Cox Proportional Hazards Model Evaluating Clinical Outcomes Associated with Antidepressant Use in the full IBD cohort.