A0384 - Impact of Biologics Therapy on the Prevalence of Parkinson’s Disease Among Patients With Inflammatory Bowel Disease: A Nationwide Population-Based Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ahmed Eltelbany, MD, MPH

Cleveland Clinic
Cleveland, OH

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

Introduction: Inflammatory bowel disease (IBD) and Parkinson’s disease (PD) are chronic progressive disorders that mainly affect different organs: the gut and brain, respectively. Increasing evidence supports reciprocal communication between the enteric and the central nervous system in disease, termed the 'gut-brain axis'. Biologics have been shown to decrease inflammation among IBD patients however the long-term neurological implications remain unclear. We sought to compare the prevalence of PD among individuals with or without IBD and to assess whether PD risk among patients with IBD is altered by biologics therapy.

Methods: We used the IBM Explorys clinical database which includes over 74 million de-identiﬁed unique patients across 300 hospitals in the United States. Patient were identiﬁed using SNOMED and ICD codes. We identified all patients (age >18 years) who were diagnosed with either Crohn’s disease (CD) or ulcerative colitis (UC). We investigated the prevalence of PD in IBD patients compared to patients with no IBD. Also, we compared the prevalence of PD between IBD patients with and without anti-TNF therapy. Odds ratios with 95% conﬁdence intervals were calculated to evaluate the risk of PD.

Results: We identified 249,480 patients with CD and 209,030 patients with UC, of whom 7,180 (2.88%) and 2,700 (1.29%) developed PD, respectively compared to 0.37% in individuals without IBD, p< 0.0001 to all. Both CD [OR: 7.91; 95% CI: 7.73-8.10] and UC [OR: 3.44; 95%CI: 3.31-3.57] patients had a significantly higher risk of PD compared to patients without IBD. 45,030 (18.0%) patients with CD and 23,110 (11.1%) patients with UC received biologics therapy. Sub-group analysis of the biologics-treated cohort was associated with a significantly lower risk of developing PD in CD [OR: 0.13; 95%CI: 0.11-0.13] and UC [OR: 0.40; 95%CI: 0.34-0.49], respectively (Figure 1).

Discussion: In this large retrospective study, we found that the prevalence of PD in patients with IBD was significantly higher than the general population. Furthermore, we found that IBD patients treated with biologics were significantly less likely to be diagnosed with PD. These findings may support a role of systemic inflammation in the pathogenesis of both diseases. Further studies are required to determine whether biologics therapy may mitigate PD risk.

Figure: Logistic Regression of Parkinson’s disease Risk in IBD, IBD; inflammatory bowel disease. Immunomodulators included Azathioprine, Methotrexate and Mercaptopurine. Other biologics included Natalizumab, Ustekinumab and Vedolizumab. TNF-a Blockers; tumor necrosis factor-alpha blocker.

Variable	Patients with PD		No PD
Variable	With IBD	Without IBD	No PD
N	9050	259900	70129700
18-65	3310 (36.6%)	26610 (10.2%)	47,919,160 (68.3%)
>65	5600 (61.9%)	226030 (87.0%)	21,034,720 (30.0%)
Female	5210 (57.6%)	112100 (43.1%)	38,353,970 (54.7%)
Caucasian	7710 (85.2%)	200420 (77.1%)	37,649,020 (53.7%)
T2DM	3160 (34.9%)	74510 (28.7%)	5,575,570 (8.0%)
Primary HTN	6200 (68.5%)	174330 (67.1%)	14,014,310 (20.0%)
Hyperlipidemia	7700 (85.1%)	144590 (55.6%)	11,635,480 (16.6%)
Obesity	2700 (29.8%)	36170 (13.9%)	5,404,010 (7.7%)
Tobacco Abuse	3710 (41.0%)	22280 (8.6%)	3,789,760 (5.4%)
Cannabis Abuse	280 (3.1%)	1540 (0.6%)	528,780 (0.75%)
Alcohol Abuse	670 (7.4%)	6530 (2.5%)	1,083,540 (1.55%)
Carbidopa-levodopa	2030 (22.4%)	130470 (50.2%)	NA
Dopamine agonists	2470 (27.3%)	145230 (55.9%)	NA
MAO-B inhibitors	310 (3.4%)	22630 (8.7%)	NA

Table: Table 1: Demographics of patients with IBD and PD. IBD; inflammatory bowel disease, PD; Parkinson’s disease, T2DM; type 2 diabetes mellitus; HTN; hypertension, MAO-B inhibitors; mono-amine oxidase B inhibitors

Disclosures:

Ahmed Eltelbany indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Osama Hamid 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.

Ahmed Eltelbany, MD, MPH¹, Khaled Alsabbagh Alchirazi, MD¹, Osama Hamid, MD, MRCPI¹, Abdul Mohammed, MD¹, Miguel Regueiro, MD². A0384 - Impact of Biologics Therapy on the Prevalence of Parkinson’s Disease Among Patients With Inflammatory Bowel Disease: A Nationwide Population-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.