P1599 - Assessing Progression of Biologic Therapies Based on Smoking Status in Patients with Crohn’s Disease

Osman Ali, MD, Raymond K. Cross, MD, MS
University of Maryland School of Medicine, Baltimore, MD

Introduction: Patients who start or continue smoking after Crohn’s disease (CD) diagnosis are at risk for worse outcomes including a greater need for advanced therapies. Compared to nonsmokers, smokers are twice as likely to experience clinical relapse regardless of treatment with immunosuppressants or biologic therapy. However, it remains unclear if exposure to smoking leads to increased sequencing through biologic therapies.

Methods: We conducted a retrospective review of The Study of Prospective Adult Research Cohort with IBD (SPARC IBD) registry collected between December 2016 to January 2021 from the University of Maryland School of Medicine’s IBD Program. A total of 619 patients were enrolled; 194 with UC and 43 patients with missing data on smoking status and/or biologic treatment were excluded resulting in a final cohort of 382 patients. The cohort was dichotomized into current smokers and nonsmokers (never/former). Our outcome of interest was number of biologics used, categorized into 0-1 biologics or ≥ 2 biologics.

Results: Three hundred and thirty nonsmokers and 52 current smokers were identified. The average age of smokers was 44±13 years versus 42±15 years in nonsmokers. Overall, 165 (43%) were male and 217 (57%) were female. The average age of diagnosis for smokers was 26±14 years versus 24±12 years for nonsmokers. In both groups, inflammatory phenotype (n=140, 40%) and ileocolonic disease location (n=179, 47%), were most common. Perianal disease was found in 88 (28%) nonsmokers and 17 (34%) smokers. Current smokers were not more likely to sequence through more biologics compared to nonsmokers (OR 1.1, 95% CI 0.58, 1.95). However, statistically significant risk factors for increased sequencing of biologics were identified. These risk factors included: prolonged disease duration (16 vs. 20 years; p=0.002), and younger age of diagnosis (mean: 22 vs. 25 years p=0.01).

Discussion: To date, this is the first study assessing the association of smoking and sequencing of biologics. Although current smokers were not found to sequence through more biologics when compared to nonsmokers, smoking is a well-established risk factor for poorer outcomes and efforts should be made to counsel patients to quit. We acknowledge limitations of our study for inability to differentiate former and never smokers, and intend to perform a sub-analysis once this information is available. Additionally, the significant association of younger age of diagnosis and increased use of biologics warrants further investigation.


Disclosures:
Osman Ali indicated no relevant financial relationships.
Raymond Cross: Abbvie – Advisory Committee/Board Member. Bristol Myers Squibb – Advisory Committee/Board Member. Eli Lilly – Consultant. Janssen – Advisory Committee/Board Member. Pfizer – Advisory Committee/Board Member. Takeda – Advisory Committee/Board Member.


Osman Ali, MD, Raymond K. Cross, MD, MS. P1599 - Assessing Progression of Biologic Therapies Based on Smoking Status in Patients with Crohn’s Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.