P4318 - Impact of Race on Clinical Outcomes in IBD Patients on Anti-TNF Monotherapy and Anti-TNF Combination Therapy With Immunomodulators: A Propensity-Matched Cohort Study

Ahmad Nawaz, MD¹, Sharifeh Almasaid, MD², Ayushi Shah, MD³, Azhar Hussain, MBBS¹, Abdelkader Chaar, MD¹, Shanti Patel, MD⁴, Fatima Khalid, MBBS⁵, Umar Hayat, MD⁶, Kelita Singh, MD¹, Ganesh Aswath, MD¹, Hafiz Muzaffar Akbar Khan, MD^1
1SUNY Upstate Medical University, Syracuse, NY; ²SUNY Upstate Medical University, Johnson City, TN; ³SUNY Upstate Medical University, Omaha, NE; ⁴Yale New Haven Hospital, New Haven, CT; ⁵Fatima Memorial Hospital, Lahore, Punjab, Pakistan; ⁶Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA

Introduction: Immunogenicity is a major contributor to anti-tumor necrosis factor (anti-TNF) treatment failure in inflammatory bowel disease (IBD). Immunomodulator & anti-TNF combination therapy is associated with a decreased risk of immunogenicity. Anti-TNF immunogenicity was recently linked to HLA-DQA1*05 genotype. This study aims to determine the impact of race on clinical outcomes of IBD patients on anti-TNF monotherapy & combination therapy.

Methods: We used TriNetX to identify pts who were 18 years or older, had a diagnosis of Ulcerative Colitis or Crohn's disease using ICD-9 and ICD-10 codes, and were on Anti-TNF monotherapy (infliximab, adalimumab, certolizumab pegol, golimumab). We excluded patients who were on other IBD medications before( vedolizumab, ustekinumab, tofacitinib, upadacitinib, risankizumab, or natalizumab). We divided them into two groups: White and Non-White. Primary outcomes were steroid use, IBD-related surgery, emergency room (ER) & urgent care (UC) visits. The secondary outcome was 10-year mortality. Outcomes were measured after a 1:1 propensity matching of the groups based on baseline demographics and comorbidities.




We also compared the same groups (White versus Non-White) with combination therapy (Anti TNF and Immunomodulators: 6- mercaptopurine, Azathioprine, methotrexate)

Results: A total of 47,158 white & 109,163 non-white IBD patients on anti-TNF monotherapy were identified prior to propensity score matching. After matching, each group consisted of 47,134 patients. White patients were noted to have increased steroid use [OR 1.841(95% CI 1.79 - 1.88)], ER visits [OR 1.06 (95% CI 1.03 - 1.09)], UC visits [OR 1.41 (95% CI 1.37- 1.45)] & 10-year mortality [OR 1.19, 95% CI (1.11 - 1.28)] as compared to non- white population. However, no significant difference was noted between both groups in IBD related surgeries [OR 0.93 (95% CI 0.84 -1.02)]. In the subsequent analysis focusing on IBD patients on combination therapy, White patients were again noted to have significant increased steroid use [OR 1.42 (95% CI 1.36 -1.49)], UC visits [OR 1.45 (95% CI 1.38 - 1.52)], & 10-year mortality between [OR 1.18 (95% CI 1.05 - 1.34)]. However, there was no difference in the ER visits & IBD related surgeries between the two groups.

Discussion: In our propensity-matched cohort, we observed that white patients had worse IBD-related clinical outcomes on anti-TNF monotherapy as well as combination therapy. Further prospective studies are needed to clarify impact of race on anti-TNF therapy.



Disclosures:


Ahmad Nawaz, MD¹, Sharifeh Almasaid, MD², Ayushi Shah, MD³, Azhar Hussain, MBBS¹, Abdelkader Chaar, MD¹, Shanti Patel, MD⁴, Fatima Khalid, MBBS⁵, Umar Hayat, MD⁶, Kelita Singh, MD¹, Ganesh Aswath, MD¹, Hafiz Muzaffar Akbar Khan, MD¹. P4318 - Impact of Race on Clinical Outcomes in IBD Patients on Anti-TNF Monotherapy and Anti-TNF Combination Therapy With Immunomodulators: A Propensity-Matched Cohort Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.