Off-label prescriptions of drugs used for the treatment of Crohn's disease or ulcerative colitis

Abstract

Background: Off-label prescribing is encountered across various fields of medicine and creates alternative treatment options, but is associated with unknown safety risks. The use of off-label drugs for the treatment of patients with inflammatory bowel diseases (IBD) has not been characterised before.

Aim: To assess the proportion and characteristics of off-label prescribing for IBD in tertiary care centres in the Netherlands.

Methods: A prospective database of IBD patients from all Dutch university hospitals was used to collect data on drug prescriptions for IBD and demographics. Drugs were classified as off-label if they were unlicensed for Crohn's disease and/or ulcerative colitis by the Medicines Evaluation Board. Uni- and multivariable analyses were used to identify patient-specific characteristics predictive of increased off-label use.

Results: For the induction and/or maintenance treatment of 4583 IBD patients, 12 651 historical and current drug records were available in the database. Of these, 2374 (19%) were considered off-label prescriptions. Out of 4583 IBD patients, 1477 (32%) were exposed to off-label drugs. Commonly prescribed off-label IBD drugs were mercaptopurine (18%), beclomethasone (12%), thioguanine (4%) and allopurinol (3%). Non-thiopurine/methotrexate off-label drugs were prescribed in 243 patients (6%), including biological agents or tofacitinib in 47 IBD patients (1%). Off-label prescriptions were more common in ulcerative colitis than Crohn's disease (37% vs 29%, P < 0.001). Smokers and patients that received ≥5 drug types during their disease course were more likely to be exposed to off-label drugs (smoking 33% vs 27% and multiple drug use 66% vs 22%, both P < 0.001).

Conclusion: About one-fifth of prescriptions for IBD were off-label and one-third of IBD patients, especially ulcerative colitis patients, were exposed to off-label drugs.

Keywords: Crohn’s disease; drugs; inflammatory bowel disease; off-label; prescriptions; therapeutic care; ulcerative colitis.

Figure 1

Prevalence rates of off‐label drug use in Crohn's disease and ulcerative colitis (n = 4583). Bar chart shows the prevalence of prescriptions per each off‐label drug among the inflammatory bowel disease population (n = 4583). Prevalence rates of each bar are split into ulcerative colitis (UC) and Crohn's disease (CD)