Topiramate Use Does Not Reduce Flares of Inflammatory Bowel Disease
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- Crockett, S.D., Schectman, R., Stürmer, T. et al. Dig Dis Sci (2014) 59: 1535. doi:10.1007/s10620-014-3040-7
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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.
To evaluate whether topiramate use is associated with clinical benefit in IBD patients.
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.
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).
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.
KeywordsDrug repositioningUlcerative colitisCrohn diseaseInflammatory bowel diseasesGlucocorticoidsCohort studies
Adjusted hazard ratios
Current procedural terminology code
U.S. Food and Drug Administration
Inflammatory bowel disease
Irritable bowel syndrome
International Classification of Diseases, 9th Revision, Clinical Modification