D0350 - Impact of Anti-TNF on the Prevalence of Hepatobiliary and Pancreatic Disorders Associated With Inflammatory Bowel Disease: A Population-Based Study

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

OH

Osama Hamid, MD, MRCPI

Cleveland Clinic
Cleveland, OH

Osama Hamid, MD, MRCPI¹, Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Rama Nanah, MD¹, Abdul Mohammed, MD¹, Miguel Regueiro, MD²
¹Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Main Campus, Cleveland, OH

Introduction: Hepatobiliary and pancreatic disorders are common extra-intestinal manifestations in inflammatory bowel diseases (IBD), both in Crohn’s Disease & Ulcerative Colitis (UC). Anti-TNF agents have been widely used in the management of IBD and are considered relatively safe. We sought to investigate the impact of anti-TNF on the prevalence of hepatobiliary and pancreatic disorders in IBD patients.

Methods: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. We identified adults who were diagnosed with either CD or UC between 1999 and 2022 who were treated with any type of anti-TNF agents. We investigated the prevalence of known hepatobiliary and pancreatic disorders in IBD including Autoimmune Hepatitis (AIH), Cholelithiasis, Primary Sclerosing Cholangitis (PSC), portal vein thrombosis (PVT), Cholangiocarcinoma (CCA), and idiopathic pancreatitis (IP) in patients with & without anti-TNF therapy. We also identified patients with CD & UC on anti-TNF who developed lupus (excluding Sulfasalazine).

Results: Out of the 69,260,780 adult patients in the database, we identified 249,480 patients with CD (0.36%) of whom 39280 received anti-TNF (15.7%). In addition, 209,020 with UC (0.30%) of whom 19860 received anti-TNF (9.50%). Figure 1 illustrates demographic characteristics of IBD patients on anti-TNF. CD patients who received anti-TNF were less likely to develop cholelithiasis (OR 0.88 [0.84-0.93]), PVT (OR 0.61 [0.50-0.74]), PSC (OR 0.59 [0.37-0.94)] or CCA (OR 0.50 [0.34-0.73]). Similarly, UC patients who received anti-TNF were less likely to develop cholelithiasis (OR 0.88 [0.79-0.97]), PVT (OR 0.65 [0.52-0.81]), PSC (OR 0.64 [0.44-0.93]), or CCA (OR 0.52 [0.36-0.75]). Both CD & UC groups on anti-TNF have a higher risk of AIH (OR 1.38 [1.13-1.69]) vs (OR 1.27 [1.02-1.58]). Likewise, both groups are at higher risk of IP (OR 1.95 [1.59-2.38] vs (OR 1.79 [1.38-2.31]). Furthermore, patients on CD & UC groups who received anti-TNF are more likely to develop lupus (OR 2.14 [1.59-2.90]) vs (OR 1.92 (1.29-2.84].

Discussion: In this large retrospective study, we found that IBD patients who were treated with anti-TNF were significantly less likely to develop cholelithiasis, PVT, PSC or CCA. However, a higher risk of AIH and IP is observed in the anti-TNF group. This relationship may reflect an autoimmune side effect of anti-TNF, e.g. lupus-like reactions. Further study is needed to explore potential causality.

Figure: Figure 1: Demographic characteristics of IBD patients on anti-TNF

	Crohn's Disease			Ulcerative Colitis
	Total (Percentage)	On Anti-TNF (percentage)	OR (95% CI)	Total (Percentage)	On Anti-TNF (percentage)	OR (95% CI)
	249,480	39280		209,020	19,860
AIH	590 (0.23%)	120 (0.030%)	1.38 (1.13-1.69)	790 (0.37%)	90 (0.45%)	1.27 (1.02-1.58)
CCA	350 (0.14%)	30 (0.07%)	0.50 (0.34-0.73)	590 (0.28%)	30 (0.15%)	0.52 (0.36-0.75)
Cholelithiasis	16420 (6.58%)	1560 (3.97%)	0.88 (0.84-0.93)	13030 (6.23%)	430 (2.16%)	0.88 (0.79-0.97)
IP	490 (0.19%)	130 (0.33%)	1.95 (1.59-2.38)	450 (0.21%)	70 (0.35%)	1.79 (1.38-2.31)
PVT	1090 (0.43%)	110 (0.28%)	0.61 (0.50-0.74)	1320 (0.63%)	80 (0.40%)	0.65 (0.52-0.81)
PSC	200 (0.08%)	20 (0.05%)	0.59 (0.37-0.94)	480 (0.22%)	30 (0.15%)	0.64 (0.44-0.93)
Lupus*	210 (0.084%)	60 (0.15%)	2.14 (1.59-2.90)	180 (0.086%)	30 (0.15%)	1.92 (1.29-2.84)

Table: Title: Hepatobiliary and pancreatic disorders in CD and UC with anti-TNF therapy
Footnote: OR: Odds Ratio; CI; Confidence Interval; AIH: Auto-immune hepatitis; CCA: Cholangiocarcinoma; IP: Idiopathic Pancreatitis; PVT: Portal vein thrombosis; PSC: Primary Sclerosing Cholangitis.
*Lupus is investigated for correlation with anti-TNF

Disclosures:

Osama Hamid indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Ahmed Eltelbany indicated no relevant financial relationships.

Rama Nanah indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Miguel Regueiro: Abbvie – Advisory Committee/Board Member, Consultant. Abbvie – Grant/Research Support. ALFASIGMA, S.p.A. – Advisory Committee/Board Member. Allergan – Advisory Committee/Board Member. Amgen – Advisory Committee/Board Member. BMS – Grant/Research Support. Bristol Meyer Squibb – Advisory Committee/Board Member, Consultant. CC360 – Royalties. Celgene – Advisory Committee/Board Member. CME Outfitters – CME Companies. Cornerstones – CME Companies. Crohn’s and Colitis Foundation as Editor-in-Chief – Royalties. Genentech – Advisory Committee/Board Member. Genentech – Grant/Research Support. Gilead – Advisory Committee/Board Member. Gilead – Grant/Research Support. HMPGlobal – CME Companies. Imedex, GI Health Foundation (GiHF) – CME Companies. Janssen – Advisory Committee/Board Member, Consultant. Janssen – Grant/Research Support. Lilly – Grant/Research Support. MDEducation – CME Companies. Medscape – CME Companies. Miraca Labs – Advisory Committee/Board Member. MJH life sciences – CME Companies. Pfizer – Advisory Committee/Board Member, Consultant. Prometheus – Advisory Committee/Board Member. Remedy – CME Companies. Salix – Advisory Committee/Board Member. Seres – Advisory Committee/Board Member. Takeda – Advisory Committee/Board Member, Consultant. TARGET Pharma Solutions – Advisory Committee/Board Member. UCB – Grant/Research Support. WebMD – CME Companies. Wolters Kluwer Health as Author/Editor of UpToDate – Royalties.

Osama Hamid, MD, MRCPI¹, Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Rama Nanah, MD¹, Abdul Mohammed, MD¹, Miguel Regueiro, MD². D0350 - Impact of Anti-TNF on the Prevalence of Hepatobiliary and Pancreatic Disorders Associated With Inflammatory Bowel Disease: A Population-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.