A0349 - Use of Neutrophil-Lymphocyte Ratio and Monocyte-Lymphocyte Ratio as Predictors of Response to Biologics in Patients With Inflammatory Bowel Disease

Introduction: Various markers, including the leukocyte differentials such as lymphocyte/monocyte ratio (LMR) and neutrophil/lymphocyte ratio (NLR), have been evaluated as surrogates for predictive and prognostic values in inflammatory bowel disease (IBD). Although, previous studies have only evaluated the use of these markers in Ulcerative colitis (UC)patients using anti-TNF medication. Our aim is to assess the association of NLR in predicting clinical response to anti-TNF, anti-integrin, and anti-interleukin 12/23 therapy in patients with UC and Crohn's disease (CD).

Methods: Retrospective analysis of adult patients over the age of 18 years with newly diagnosed IBD necessitating biologic therapy at the Cleveland clinic between 2015 and 2019. Patients with active infections, hematologic, neoplastic disorders, and autoimmune diseases were excluded. Descriptive and logistic regression analyses were performed. Patients with clinical response and continued use of biologics at 52 weeks were deemed responsive to treatment (n=29) and patients whose biologics were discontinued prior to 52 weeks were non-responders (n= 20).

Results: A total of 49 patients were included. The baseline characteristics of the 2 groups are mentioned in Table 1. Both groups were noted to have a higher percentage of UC patients. Responders were noted to have a similar number of patients on Anti-TNF (48.3%) and non-Anti-TNF (51.7%) medications as opposed to 78.9% of non-responders Anti- TNF. Baseline and follow-up NLR were both higher in the non-responders (4.85 ± 2.91, 3.57 ± 2.68 resp.) when compared to responders (3.64 ± 2.74, 2.70 ± 1.47 resp.). On logistic regression, the need to switch treatment was noted to be statistically significantly related to both initial (OR=1.58 95% CI= 1.07-2.34; p=0.02) and follow-up (OR=2.38 95% CI= 1.07-5.27; p=0.03) NLR when controlled for confounding factors (steroid use, IBD type, and type of biologic).

Discussion: This is the first study supporting the use of NLR as an inexpensive, non-invasive marker for clinical response in patients with Crohn's disease as well as patients on non-anti-TNF biologics. Our results demonstrate that the absolute NLR at baseline and follow-up is higher for clinical nonresponders requiring a change in therapy. The multivariate analysis shows that NLR predicts the need for change in therapy, independent of the IBD phenotype and the type of biologic used. Further prospective trials are needed to verify these findings in both UC and CD.