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The Burden of Comedication Among Patients with Inflammatory Bowel Disease

Buckley, Jessie P. MPH*,†; Kappelman, Michael D. MD, MPH; Allen, Jeffery K. MS; Van Meter, Susan A. MD§; Cook, Suzanne F. PhD

doi: 10.1097/01.MIB.0000435442.07237.a4
Original Clinical Articles

Background: Polypharmacy is of growing concern in the chronically ill, including individuals with inflammatory bowel disease (IBD). The authors aimed to describe the prevalence and predictors of non-IBD medication use and to compare drug use among individuals with and without IBD.

Methods: This cross-sectional study included members of health plans included in the Thomson Reuters MarketScan databases with continuous enrollment during 2009 and 2010. Patients with IBD were identified through diagnosis codes and IBD medication dispensings and matched to 5 individuals without IBD. The prevalences of dispensed prescriptions for analgesics (narcotics, nonnarcotics), psychiatric medications (anxiolytics/sedatives/hypnotics, antidepressants), and broad drug classes defined by the Anatomic Therapeutic Classification system were estimated. Predictors of non-IBD medication use and comparisons of drug use by IBD status were evaluated using logistic regression.

Results: The prevalence of medication use was higher among patients with IBD than matched members of the general population for nearly every drug class examined, including narcotic analgesics (48.1% versus 34.1%), nonnarcotic analgesics (12.8% versus 8.1%), anxiolytics/sedatives/hypnotics (25.8% versus 16.7%), and antidepressants (28.3% versus 19.4%). Medicaid insurance, middle age, gastrointestinal surgery, Crohn's disease, and increasing number of inpatient, and outpatient, and prescription events were significantly associated with analgesic and psychiatric medication use among patients with IBD. Psychiatric drug dispensings were more common among female IBD patients than male patients.

Conclusions: Patients with IBD have increased medication use, particularly of analgesic and psychiatric drugs. IBD care providers should be aware of polypharmacy and its potential for drug interactions.

Article first published online 7 November 2013Supplemental Digital Content is Available in the Text.

*Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;

Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, North Carolina;

Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and

§Neurosciences Therapy Area, GlaxoSmithKline, Research Triangle Park, North Carolina.

Reprints: Jessie P. Buckley, MPH, Department of Epidemiology, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435 (e-mail:

Supported by GlaxoSmithKline.

S. F. Cook, J. K. Allen, and S. A. Van Meter are employees of GlaxoSmithKline. J. P. Buckley received funding through a research assistantship at GlaxoSmithKline. M. D. Kappelman is a consultant to GlaxoSmithKline and has received research support from Janssen Biotech.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received August 05, 2013

Accepted September 11, 2013

© Crohn's & Colitis Foundation of America, Inc.
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