P0521 - Lower Therapeutic Response to Anti-TNF Agents in African Americans with Inflammatory Bowel Disease

Anna H. Owings, DO¹, Landen Burstiner, BS², Amor Royer, MD¹, Jeshanah Johnson, BS¹, Madelyn Barr, BS¹, Yousef Hreish, BS¹, Lauren Bradley, MD¹, Kane Edwards, MD¹, Himmat Brar, MD¹, Hannah Laird, BS¹, Brian Claggett, PhD³, Julia Liu, MD⁴, Sarah C. Glover, DO^1
1University of Mississippi Medical Center, Jackson, MS; ²Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL; ³Harvard Medical School, Boston, MA; ⁴Morehouse School of Medicine, Atlanta, GA

Introduction: The incidence of Inflammatory Bowel Disease (IBD) in minority populations, particularly African Americans (AA) has risen sharply over the past three decades, with prevalence now approaching that of Caucasians (CA). AAs also have more severe disease phenotypes, such as peri-anal and fistulizing disease, but there is a paucity of data on their therapeutic response to biologic agents. Anti-Tumor Necrosis Factor (TNF) antibodies have been a cornerstone treatment for the induction and maintenance in IBD. The goal of this study was to examine the utilization, therapeutic efficacy, side effects, and outcomes between AA and CA IBD patients treated with anti-TNFs.

Methods: We performed a retrospective cohort study in an integrated tertiary university system. Patients were identified by ICD-10 codes in electronic medical records for either Crohn’s Disease (CD) or Ulcerative Colitis (UC). Diagnoses were manually chart checked and confirmed using endoscopic findings, pathology, and imaging. Inclusion criteria required diagnosis of CD or UC and seen in gastroenterology clinic. Patients on an anti-TNF (infliximab or adalimumab) with subsequent drug levels and anti-drug antibody titers were included. Patients who developed allergic reactions to anti-TNF were excluded.

Results: In our cohort of 1,152 IBD patients, 118 (60-AA, 58-CA) were included in this analysis, 94 with CD, 24 with UC. AA CD patients had higher prevalence of fistulizing phenotype (48% vs. 29%, p=0.034), although similar rate of anti-TNF use as CA CD patients. AA patients had more hospitalizations (0.6 ± 1.02 vs. 0.22 ± 0.67) per patient (p=0.022). On anti-TNFs, AA were more likely to reach therapeutic titers but had radiological/endoscopic/histopathologic evidence of active disease (61% vs. 50%, p=0.026), requiring more IBD-related surgeries (8.7% vs. 0%, p=0.49) compared to CA patients. Side effects including allergic reaction, rash/psoriasis and arthralgia were more common in CA IBD patients on infliximab compared to AA (21.4% vs. 2.5%, p=0.01).

Discussion: Our study demonstrated that AA IBD patients on anti-TNF have higher prevalence of active disease, requiring more surgeries and hospitalizations despite having adequate therapeutic levels of drugs. Our results highlight the importance for need of more research into the therapeutic response to biologics in minority IBD patients.



Disclosures:


Anna H. Owings, DO¹, Landen Burstiner, BS², Amor Royer, MD¹, Jeshanah Johnson, BS¹, Madelyn Barr, BS¹, Yousef Hreish, BS¹, Lauren Bradley, MD¹, Kane Edwards, MD¹, Himmat Brar, MD¹, Hannah Laird, BS¹, Brian Claggett, PhD³, Julia Liu, MD⁴, Sarah C. Glover, DO¹. P0521 - Lower Therapeutic Response to Anti-TNF Agents in African Americans with Inflammatory Bowel Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.