P4319 - Immunomodulator Therapy is Associated With Higher Incidence of Primary Sclerosing Cholangitis and Colorectal Cancer Compared to Biologic Therapy: A Propensity-Matched Cohort Study
Ahmad Nawaz, MD, Ayushi Shah, MBBS, Abdelkader Chaar, MD, Kelita Singh, MD, Ganesh Aswath, MD, Hafiz Muzaffar Akbar Khan, MD, Savio John, MD, FACG SUNY Upstate Medical University, Syracuse, NY
Introduction: There is limited data regarding incidence of Primary Sclerosing Cholangitis (PSC) and Colorectal Cancer (CRC) in IBD patients based on the treatment regimen used for induction and maintenance of remission. Recent study from Japan showed that the biologic use was associated with lower risk of advanced IBD- associated cancer in patients with Ulcerative colitis. The aim of our study was to investigate the incidence of PSC and CRC in IBD patients based on the treatment therapy (Immunomodulator vs. biologic agents).
Methods: We used TRNETX a federated cloud-based network research database comprising of multiple health care organizations (HCOs) globally to identify patients aged more than 18 years with IBD using appropriate ICD 9 and 10 codes. The data was collected from November 2000 to June 2024. All patients with diagnosis of PSC or CRC were excluded from the cohort. Patients were primarily divided into two groups: IBD + Immunomodulator therapy (6- mercaptopurine and azathioprine) and IBD + Biologics (infliximab, adalimumab, golimumab, certolizumab pegol, risankizumab, ustekinumab, upadacitinib, tofacitinib, vedolizumab and natalizumab). The primary outcome was incidence of PSC, and the secondary outcome was the incidence of CRC. Outcomes were measured for twenty years. The outcomes were measured after a 1:1 propensity matching of the groups based on baseline demographics and co-morbidities.
Results: A total of 98,983 & 185,549 patients were identified in the IBD + immunomodulators group and IBD + biologics cohort. After propensity matching, each group had 97,983 patients. 593 IBD patients on immunomdulators developed PSC as compared to 433 IBD patients that were on biolgics. There was an increased incidence of PSC [OR 1.37 (95% CI 1.21- 1.55)] and CRC [OR 1.32 (95% CI 1.18 – 1.46)] in the IBD patients who were treated with immunomodulators only as compared to IBD patients that were treated with biologics.
Discussion: In extensive cohorts matched for propensity, there was a higher incidence of primary sclerosing cholangitis and colorectal cancer in the IBD patients that were treated with immunomodulators as compared to IBD patients that were treated with biologics. Biologics protective role against IBD assocaited cancers needs to be investigated by further prospective studies.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Ahmad Nawaz indicated no relevant financial relationships.
Ayushi Shah indicated no relevant financial relationships.
Abdelkader Chaar indicated no relevant financial relationships.
Kelita Singh indicated no relevant financial relationships.
Ganesh Aswath indicated no relevant financial relationships.
Hafiz Muzaffar Akbar Khan indicated no relevant financial relationships.
Savio John indicated no relevant financial relationships.
Ahmad Nawaz, MD, Ayushi Shah, MBBS, Abdelkader Chaar, MD, Kelita Singh, MD, Ganesh Aswath, MD, Hafiz Muzaffar Akbar Khan, MD, Savio John, MD, FACG. P4319 - Immunomodulator Therapy is Associated With Higher Incidence of Primary Sclerosing Cholangitis and Colorectal Cancer Compared to Biologic Therapy: A Propensity-Matched Cohort Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
