Polypharmacy is a risk factor for disease flare in adult patients with ulcerative colitis: a retrospective cohort study

Abstract

Background/aims: Polypharmacy is a common clinical problem with chronic diseases that can be associated with adverse patient outcomes. The present study aimed to determine the prevalence and patient-specific characteristics associated with polypharmacy in an ulcerative colitis (UC) population and to assess the impact of polypharmacy on disease outcomes.

Methods: A retrospective chart review of patients with UC who visited a tertiary medical center outpatient clinic between 2006 and 2011 was performed. Polypharmacy was defined as major ( ≥ 5 non-UC medications) or minor (2-4 non-UC medications). UC medications were excluded in the polypharmacy grouping to minimize the confounding between disease severity and polypharmacy. Outcomes of interest include disease flare, therapy escalation, UC-related hospitalization, and surgery within 5 years of the initial visit.

Results: A total of 457 patients with UC were eligible for baseline analysis. Major polypharmacy was identified in 29.8% of patients, and minor polypharmacy was identified in 40.9% of the population. Polypharmacy at baseline was associated with advanced age (P< 0.001), female sex (P= 0.019), functional gastrointestinal (GI) disorders (P< 0.001), and psychiatric disease (P< 0.001). Over 5 years of follow-up, 265 patients remained eligible for analysis. After adjusting for age, sex, functional GI disorders, and psychiatric disease, major polypharmacy was found to be significantly associated with an increased risk of disease flare (odds ratio, 4.00; 95% confidence interval, 1.66-9.62). However, major polypharmacy was not associated with the risk of therapy escalation, hospitalization, or surgery.

Conclusions: Polypharmacy from non-inflammatory bowel disease medications was present in a substantial proportion of adult patients with UC and was associated with an increased risk of disease flare.

Keywords: Colitis, ulcerative; Disease flare; Polypharmacy.

Fig. 1.

Differences in OR with 95% CI between patients in major polypharmacy class (n =75) and those without polypharmacy (n=89) were assessed using multiple logistic regression model after adjusting for age, sex, functional GI disorders and psychiatric disease. Major polypharmacy: >5 non-UC medications. Y-axis is logtransformed (P<0.05).