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The effect of Low Dose Naltrexone on Medication in Inflammatory Bowel Disease: A Quasi Experimental before-and-after Prescription Database Study

Title
The effect of Low Dose Naltrexone on Medication in Inflammatory Bowel Disease: A Quasi Experimental before-and-after Prescription Database Study
Publication Type
Journal Article
Research Type
Human
Reported as
Case Report/Series/Restrospective Study
Date
January 27, 2018
Authors
Guttorm Raknes, Pia Simonsen, Lars Småbrekke
Institution
University Hospital of North Norway
Link
Abstract

BACKGROUND AND AIMS: Low dose naltrexone (LDN) is a controversial off-label treatment used by many Crohn’s disease (CD) and ulcerative colitis (UC) patients. A small number of preliminary studies indicate that LDN might be beneficial in CD, but evidence is too scarce to demonstrate efficacy. We wanted to examine whether initiation of LDN therapy by patients with inflammatory bowel disease (IBD) was followed by changes in dispensing of relevant medication.

METHODS: We performed a quasi-experimental before and after study following a sudden increase of LDN use in the Norwegian population in 2013. IBD patients were identified among all patients that had at least one LDN prescription recorded in the Norwegian Prescription Database (NorPD) in 2013. Drug dispensing two years before and after the first LDN prescription was compared.

RESULTS: We identified 582 IBD patients. Among the 256 patients that became persistent LDN users, there were reductions in number of users of all examined drugs (-12%), intestinal anti-inflammatory agents (-17%), other immunosuppressants (-29%), intestinal corticosteroids (-32%), and aminosalicylates (-17%). In subgroups with identified CD and UC patients, there were significant reductions in number of users of intestinal corticosteroids (CD: -44%, UC: -53%) and systemic corticosteroids (UC: -24%). No significant differences in cumulative defined daily doses were observed.

CONCLUSIONS: Our findings imply that the initiation of LDN in IBD is followed by reduced dispensing of several drugs essential in the treatment of CD and UC.