BACKGROUND: Animal studies indicate a potential protective role of antidepressant medication (ADM) in models of colitis but the effect of their use in humans with ulcerative colitis (UC) remains unclear.
OBJECTIVE: To study the relationship between ADM use and corticosteroid dependency in UC.
DESIGN: Using the Clinical Practice Research Datalink we identified patients diagnosed with UC between 2005 and 2016. We grouped patients according to serotonin selective reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) exposure in the 3 years following diagnosis: 'continuous users', 'intermittent users' and 'non-users'. We used logistic regression to estimate the adjusted risk of corticosteroid dependency between ADM exposure groups.
RESULTS: We identified 6373 patients with UC. Five thousand two hundred and thirty (82%) use no ADMs, 627 (10%) were intermittent SSRI users and 282 (4%) were continuous SSRI users, 246 (4%) were intermittent TCA users and 63 (1%) were continuous TCA users.Corticosteroid dependency was more frequent in continuous SSRI and TCA users compared with non-users (19% vs 24% vs 14%, respectively, chi(2) p=0.002). Intermittent SSRI and TCA users had similar risks of developing corticosteroid dependency to non-users (SSRI: OR 1.19, 95% CI 0.95 to 1.50, TCA: OR 1.14, 95% CI 0.78 to 1.66). Continuous users of both SSRIs and TCAs had significantly higher risks of corticosteroid dependency compared with non-users (SSRI: OR 1.62, 95% CI 1.15 to 2.27, TCA: OR 2.02, 95% CI 1.07 to 3.81).
CONCLUSIONS: Continuous ADM exposure has no protective effect in routine clinical practice in UC and identifies a population of patients requiring more intensive medical therapy. ADM use is a flag for potentially worse clinical outcomes in UC.
|投稿者||Blackwell, Jonathan; Alexakis, Christopher; Saxena, Sonia; Creese, Hanna; Bottle, Alex; Petersen, Irene; Hotopf, Matthew; Pollok, Richard C G|
|組織名||Imperial College London Department of Primary Care and Public Health, London, UK;email@example.com.;Department Gastroenterology, St George's University Hospitals NHS Foundation;Trust, London, UK.;The POP-IBD study group, London, UK.;Gastroenterology, Royal Surrey County Hospital NHS Foundation Trust, Guildford,;UK.;Imperial College London Department of Primary Care and Public Health, London, UK.;Primary Care and Public Health, Imperial College, London, UK.;Dr Foster Unit, School of Public Health, Faculty of Medicine, Imperial College,;London, UK.;Department of Primary Care & Population Health, University College London,;Division of Academic Psychiatry, Institute of Psychiatry Psychology and;Neuroscience, London, UK.;South London and Maudsley Mental Health NHS Trust, London, London, UK.;Institute for Infection and Immunity, St George's University of London, London,|