Response to the Letter to the Editor, “Refining the Understanding of Cannabis Impact on Inflammatory Bowel Disease Outcomes: Recommendations for Enhanced Research and Healthcare Practices”

To the Editors,

We appreciate the opportunity to respond to the comments submitted by Guo et al. regarding our recent article.¹ In brief, we agree with several concerns or suggestions that they shared in their letter. For example, they point out a number of potential methodological shortcomings associated with our article, including the lack of detailed data regarding cannabinoid dosing characteristics and the limitations of relying upon ICD-10 and CPT codes for data abstraction. We highlighted the latter point in our “Discussion” section, and certainly agree that incorporation of data relating to cannabis type and administration (as possible) should be an important consideration in future studies focused on this topic. We also appreciate the suggestion about incorporating imputation techniques and sensitivity analyses to help fill in potential “gaps” of data in the event that studies utilizing similar data sets are undertaken in the future.

There were other points made in the letter from Guo et al. that we do not necessarily agree with. Specifically, they suggest that the database relied upon for this study (ie, the TriNetX Diamond Network) “may not capture the full diversity of IBD patients.” It is not particularly clear what this statement is based on. We agree with the concept and importance of using a larger and progressively more representative source of data. There are certainly limitations to what can be abstracted from this resource (as outlined above). However, the network and database in question currently represent one of the largest and most comprehensive sources of information in the world for population-based studies and include data from a wide variety of healthcare centers located around the world.² In addition, it is difficult to assess (or certainly act upon) this type of comment without having specific alternative resources for comparison. Finally, Guo et al. recommend that healthcare providers develop “emergency response plans and educational programs” focused on cannabis-related complications for individuals with IBD. We wholeheartedly agree with the concept of educating patients and healthcare providers about cannabis in the context of IBD. However, we would caution the readers about drawing too many firm conclusions about the relative safety profile of cannabis in this setting. To be clear, we are not advocating for specific health care approaches based on the results of this study. The only conclusion we shared at the end of this paper is that this topic warrants further, careful study. This is all the more important due to the varied and occasionally conflicting findings of this and previous studies on this subject, making it very challenging to draw firm conclusions or develop clear clinical guidelines as of yet.^3-5

Funding

The authors of this manuscript were supported by a grant from the National Institutes of Health and National Institute of Diabetes and Digestive and Kidney Diseases (R01DK122364; M.D.C.) and a grant from the National Center for Complementary and Integrative Health (R01AT012053; K.E.V.). Access to TriNetx was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1 TR002014. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Conflicts of Interest

None declared.