Are We Overlooking Long-Term Risks in IBS Management? New 20-Year Safety Data, With Ali Rezaie, MD - HCPLive

Are We Overlooking Long-Term Risks in IBS Management? New 20-Year Safety Data, With Ali Rezaie, MD  HCPLive

Management of irritable bowel syndrome (IBS) has undergone a notable evolution in recent decades, shifting from largely empirical, symptom-based treatment toward a more nuanced, mechanism-driven approach. However, as clinicians increasingly rely on long-term pharmacotherapy for a condition often diagnosed in early adulthood, questions around the durability and safety of these treatments have come into sharper focus.

A recent large-scale study led by Ali Rezaie, MD, medical director of the GI Motility Program at Cedars-Sinai, sought to address a critical gap in the literature surrounding the long-term mortality risk associated with commonly used IBS medications. His research utilized nearly 2 decades of electronic health records from > 650,000 US adults with IBS, making it the largest real-world study to examine the long-term safety of IBS treatments.

“One important thing about the irritable bowel syndrome is that a lot of patients are diagnosed in their 20s, 30s, or 40s. If you start them on a medication, this is not necessarily a curable disease, so they will be on that medication for years and decades,” Rezaie explained. “The issue is that when we do clinical trials using medications, they have a limited timeframe and they're generally small, so a rare side effect or long-term side effects will not pop up in those types of research. It's very important when we are treating patients with a specific medication to know whether there are risks associated with it.”

He and colleagues performed a retrospective cohort study using a nationwide US electronic health record database from January 2005 to January 2023. Their 1:1 propensity score-matched cohort included 669,083 adults with IBS. Patients were grouped by pharmacotherapy use, with subgroup analyses for IBS with diarrhea (IBS-D) and IBS with constipation (IBS-C). Rezaie noted the analysis accounted for more than 50 variables—including comorbidities, concomitant medications, demographics, and lifestyle factors—to minimize confounding.

Results showed antidepressant use was associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.35; 95% CI, 1.26–1.45; mortality rate, 1.6% vs 1.0%) and remained consistent across antidepressant subclasses and demographic subgroups.

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