Digestive Diseases and Sciences

, Volume 59, Issue 7, pp 1535–1543

Topiramate Use Does Not Reduce Flares of Inflammatory Bowel Disease

Authors

    • Division of Gastroenterology and HepatologyUniversity of North Carolina
  • Robin Schectman
    • Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina
  • Til Stürmer
    • Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina
  • Michael D. Kappelman
    • Division of Pediatric GastroenterologyUniversity of North Carolina School of Medicine
Original Article

DOI: 10.1007/s10620-014-3040-7

Cite this article as:
Crockett, S.D., Schectman, R., Stürmer, T. et al. Dig Dis Sci (2014) 59: 1535. doi:10.1007/s10620-014-3040-7

Abstract

Background

Additional medications are needed for inflammatory bowel disease (IBD) as existing therapies are incompletely effective and can be costly and toxic. Preclinical studies suggest that topiramate (an anticonvulsant) may have disease-modifying properties in IBD, but its efficacy in humans is unknown.

Aim

To evaluate whether topiramate use is associated with clinical benefit in IBD patients.

Methods

We conducted a retrospective cohort study using administrative claims data from the MarketScan databases. Persons with IBD were identified between 2000 and 2010. New users of topiramate were compared with users of other anticonvulsant and anti-migraine medications. The primary outcome was a new prescription for an oral steroid (≥14 days). Secondary outcomes included initiation of biologic agents, abdominal surgery, and hospitalization. Cox proportional hazard modeling was used to adjust for potential confounders.

Results

We identified 773 new users of topiramate and 958 users of comparator drugs. After adjusting for potential confounders, topiramate use was not associated with the primary outcome of steroid prescriptions [hazard ratio (HR) 1.14, 95 % confidence interval (CI) 0.74, 1.73]. Results did not differ significantly by IBD subtype. There was no difference between topiramate users and users of comparator drugs with respect to post-exposure initiation of biologic agents (HR 0.93, 95 % CI 0.39, 2.19), abdominal surgery (HR 1.04, 95 % CI 0.17, 6.41), or hospitalization (HR 0.86, 95 % CI 0.62, 1.19).

Conclusion

In this large U.S. administrative claims study, topiramate use was not associated with markers of IBD flares. These results cast doubt on whether topiramate may be an effective adjunct to current IBD therapy.

Keywords

Drug repositioningUlcerative colitisCrohn diseaseInflammatory bowel diseasesGlucocorticoidsCohort studies

Abbreviations

aHR

Adjusted hazard ratios

CD

Crohn’s disease

CI

Confidence interval

CPT

Current procedural terminology code

FDA

U.S. Food and Drug Administration

IBD

Inflammatory bowel disease

IBS

Irritable bowel syndrome

ICD-9-CM

International Classification of Diseases, 9th Revision, Clinical Modification

6-MP

6-Mercaptopurine

UC

Ulcerative colitis

Copyright information

© Springer Science+Business Media New York 2014