A0365 - Crohn’s Disease Patients Treated With Anti-TNFs Have Lower Rates of Interstitial Lung Disease

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Khaled Alsabbagh Alchirazi, MD

Cleveland Clinic
Cleveland, OH

Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Abdul Mohammed, MD¹, Antoine Boustany, MD, MPH², Eduard Krishtopaytis, MD², Miguel Regueiro, MD³
¹Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Cleveland Clinic Main Campus, Cleveland, OH

Introduction: Patients with Crohn’s Disease (CD) are at increased risk of pulmonary manifestations in particular interstitial lung disease (ILD). Chronic inflammation state might be contributing to this condition. Few studies reported that Anti-Tumor Necrosis Factors (Anti-TNFs) may decrease the pulmonary inflammation in Rheumatoid arthritis patients, but the sample size was very small. Here we aim to investigate the prevalence of ILD in CD patients with and without anti-TNF therapy in large database.

Methods: We queried a multi-institutional database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) with a concomitant diagnosis of CD and ILD. between 1999-2022. The study population was divided into two subgroups based on the presence or absence of medical intervention such as, anti-TNF therapy, Ustekinumab, Vedolizumab, Methotrexate, 5-Aminosalicylates (5-ASA). A univariate binary logistic model was constructed using medical intervention as the dependent variable.

Results: Of the 70, 301,380 individuals in the database from 1999 to present, we identified 249,300 (0.3%) patients with CD, of whom 40,840 (16.4%) patients received anti-TNFs. CD patients were 59.4% females, 76% Caucasian, and 70% in 18-65 years age group. Compared to the general population, patients with CD had higher association risk of ILD diagnosis [OR: 4.25; 95% CI: 4.15-4.36, P< 0.0001]. Among CD, predictors of having ILD included being elderly ( >65 years old), male, Caucasian, smokers, has history of type 2 diabetes and obesity (P< 0.0001). CD patients treated with anti-TNF had lower rates of ILD [OR: 0.89; 95% CI: 0.83-0.95, P= 0.0011] whereas 5-ASA, methotrexate and vedolizumab had higher rates of ILD [OR: 1.22; 95% CI: 1.15-1.29, P< 0.0001], [OR: 1.96; 95% CI: 1.78-2.17, P< 0.0001] and [OR: 1.21; 95% CI: 1.04-1.39, P= 0.0114], respectively. Ustekinumab had no significant effect [OR: 1.17; 95% CI: 0.98-1.39, P= 0.0897].

Discussion: In this large study, we found a higher risk association between CD and ILD. We found that CD patients who were treated with anti-TNF were significantly less likely to have ILD when compared to IBD individuals who were never treated with anti-TNF. More clinical studies are needed to investigate if anti-TNF have a lung protective effect related to anti-inflammatory mechanism.

Figure: Figure 1: Overall Risk and Predictors of Interstitial lung disease Among Crohn's Disease. Univariate analysis used to calculate OR. OR; odds ratio, CI; confidence interval.

Disclosures:

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Ahmed Eltelbany indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Antoine Boustany indicated no relevant financial relationships.

Eduard Krishtopaytis 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.

Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Abdul Mohammed, MD¹, Antoine Boustany, MD, MPH², Eduard Krishtopaytis, MD², Miguel Regueiro, MD³. A0365 - Crohn’s Disease Patients Treated With Anti-TNFs Have Lower Rates of Interstitial Lung Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.