title: Topiramate use does not reduce flares of inflammatory bowel disease.
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.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors: Division of Gastroenterology and Hepatology, University of North Carolina, CB 7080, Chapel Hill, NC, 27599, USA, sethc@med.unc.edu.
authors: Seth D
authors: SD
authors: Crockett
authors: Robin
authors: R
authors: Schectman
authors: Til
authors: T
authors: Stürmer
authors: Michael D
authors: MD
authors: Kappelman
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000188:drug therapy; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000188:drug therapy; D017891:Pharmacoepidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications / Q000188:drug therapy; D000077236:Topiramate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose