Association of ischaemic colitis with triptans treatment-A nested case control study in the United Kingdom using the health improvement network primary care data

Background: Ischaemic colitis (IC) is the most common form of intestinal ischaemia and may be caused by medicines such as alosetron. Triptans are selective serotoninergic receptor agonists and are approved for acute treatment of migraine. Although triptans are highly selective for vascular receptors in the nervous system, they may also cause vascular constriction outside the cerebral vascular bed. An association between use of triptans and IC has been investigated, with conflicting results.

Objectives: To estimate the relation between IC and triptans use in a population‐based cohort with migraine.

Methods: We conducted a nested case‐control study in The Health Improvement Network, a primary care database in the United Kingdom, in a cohort of patients aged 18 and over with a diagnosis of migraine or cluster headache between January 1, 2003, and December 31, 2015, with at least 1 year of valid data prior to cohort entry. Cases of incident IC were identified through READ codes and matched by age and sex to a maximum of 100 controls using the density sampling method. Drug exposure was assessed using prescription data in the 24 months before the index date. Odds ratios were estimated through conditional logistic regression, adjusted for known confounders from literature which, in univariable models, changed the risk estimate for drug exposure more than 10%.

Results: The migraine cohort consisted of 293 037 patients. Mean age at entry was 43.6 years (interquartile range 31‐54), 74.3% were females, and 32% used triptans during the study period. We identified 41 incident cases of IC during the study period (incidence rate of 2.3/100 000 person‐years), who were matched to 4005 controls. Covariates were balanced between cases and controls except for opioid use, which was higher in cases than in controls (66% vs 42%, p = 0.001). Use of triptans in the 12 months prior to the index date compared with no use was significantly related to IC (OR = 2.29, 95% CI 1.02‐5.15). When most recent use was between 12 and 24 months prior to index date, no significant relation was found (OR = 1.90, 95% CI 0.44‐8.13).

Conclusions: In a cohort of migraine patients, cases of IC had significantly more triptan use in the previous year than controls. Considering the limited number of cases, this finding should be replicated in a better powered study.