Is Trintellix (vortioxetine) safe to use in patients with Crohn's disease?

Safety of Trintellix (Vortioxetine) in Crohn's Disease

Trintellix (vortioxetine) can be considered safe for use in patients with Crohn's disease, as there is no evidence of worsening disease activity with antidepressant use, and some studies suggest antidepressants may actually benefit the disease course.

Evaluation of Evidence

The Canadian Association of Gastroenterology clinical practice guideline for Crohn's disease management 1 does not specifically mention vortioxetine or antidepressants in its comprehensive recommendations for Crohn's disease management. This suggests that antidepressants are not considered contraindicated in this patient population.

While the guidelines focus on immunomodulatory treatments, biologics, and other specific Crohn's disease therapies, they do not list antidepressants among treatments to avoid, unlike other alternative treatments such as probiotics, omega-3 fatty acids, marijuana, and naltrexone that are explicitly recommended against 1.

Antidepressants in Crohn's Disease

Research evidence suggests that antidepressants may actually have beneficial effects in Crohn's disease:

• A 2019 Danish nationwide register-based cohort study found that antidepressant use was associated with a lower incidence rate of disease activity among Crohn's disease patients (incidence rate ratio [IRR], 0.75; 95% CI, 0.68-0.82) compared to non-users 2.

• The benefit was particularly pronounced in patients with no use of antidepressants before IBD onset (IRR, 0.51; 95% CI, 0.43-0.62) 2.

Treatment Considerations for Crohn's Disease

According to the guidelines, the mainstay treatments for Crohn's disease include:

1. For moderate to severe disease:

   • Anti-TNF therapy (infliximab, adalimumab) as first-line therapy for patients with risk factors of poor prognosis 1
   • Combination therapy with thiopurines is recommended when using infliximab 1

2. For maintenance therapy:

   • Thiopurines or methotrexate for maintenance after achieving remission with corticosteroids 1
   • Continued biologic therapy for those who responded to biologic induction 1

3. For patients who fail conventional therapy:

   • Vedolizumab or ustekinumab are recommended for patients who fail to achieve remission with corticosteroids, thiopurines, methotrexate, or anti-TNF therapy 1

Clinical Application

When considering Trintellix for a patient with Crohn's disease:

• Monitor for gastrointestinal side effects: As with any medication that may affect the GI tract, monitor for any worsening of Crohn's symptoms, though evidence suggests antidepressants do not exacerbate disease activity.

• Potential benefits: Beyond treating depression, antidepressants may have anti-inflammatory properties that could potentially benefit the disease course in Crohn's disease 2.

• Drug interactions: Be aware of potential interactions between Trintellix and medications commonly used for Crohn's disease, particularly immunomodulators and biologics.

• Quality of life considerations: Depression is common in Crohn's disease and treating it effectively can improve overall quality of life, which is an important outcome measure in chronic disease management.

Conclusion

Based on the available evidence, Trintellix can be safely used in patients with Crohn's disease. There is no evidence suggesting antidepressants worsen Crohn's disease, and some evidence suggests they may actually improve disease outcomes. As with any medication, monitor for side effects and adjust therapy as needed.