P0703 - Assessing the Risk of Pancreatic Diseases in Inflammatory Bowel Disease Patients on Biological Therapy: A Retrospective Cohort Study Using a Large Database

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

TQ

Thabet Qapaja, MD

Cleveland Clinic
Cleveland, OH

Thabet Qapaja, MD¹, Khaled Alsabbagh Alchirazi, MD¹, Osama Abu-Shawer, MD, MS¹, Motasem Alkhayyat, MD¹, Almaza Albakri, MD², Serge Baroud, MD³, Miguel Regueiro, MD⁴
¹Cleveland Clinic, Cleveland, OH; ²King Hussein Medical Center, Amman, 'Amman, Jordan; ³MetroHealth Medical Center, Cleveland, OH; ⁴Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH

Introduction: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder with multiple extra‐intestinal manifestations. While pancreatic involvement in IBD is not uncommon, the risk for pancreatic disease in IBD patients undergoing biological therapy is currently unclear. We aim in our study to assess the risk of different pancreatic diseases in IBD patients on biological therapy using a large database.

Methods: We conducted a retrospective cohort study using the TrinNetX database, a multi-institutional database. The study included all adult patients aged 18 years or older diagnosed with CD or UC between the years 2002 and 2022 who were treated with biological therapy (Infliximab, Adalimumab, Golimumab, Certolizumab, Vedolizumab, Natalizumab, or Ustekinumab) or were not treated with biological therapy. The primary objective was to compare the risk of various pancreatic diseases between patients who received biologics and those who did not, at least one month after the start of therapy. We employed 1:1 propensity score matching for age, gender, race, tobacco use, alcohol use, azathioprine, mercaptopurine, methotrexate, 5-ASA medications, and steroids to ensure balanced groups.

Results: Following matching, both CD cohorts had 54,541 patients each, while both UC cohorts had 29,573 patients each. Patients with CD or UC who were treated with biological therapy had a lower risk of chronic pancreatitis, exocrine pancreatic insufficiency, and pancreatic cancer compared to those who were not treated with biological therapy. However, CD patients treated with biological therapy had a higher risk of pancreatic cysts and pancreatic pseudocysts. The risk of acute pancreatitis, necrotizing pancreatitis, and benign pancreatic neoplasms did not differ significantly between CD and UC patients who received biological therapy and those who did not.

Discussion: Our study found that IBD patients on biological therapy have a lower risk of developing chronic pancreatitis, exocrine pancreatic insufficiency, and pancreatic cancer compared to those not on biological therapy. Our findings suggest that biological therapy for IBD may confer some protective effects against certain pancreatic diseases, possibly due to reduced inflammation. Further studies are needed to explore the underlying mechanisms and long-term effects of biological therapy on pancreatic manifestations in IBD patients.

Pancreatic Outcomes in CD on Biologics vs No Biologics
Outcome	CD on biologics N=54,541	CD not on biologics N=54,541	OR	95% CI	p-value
Acute pancreatitis	1,302 (2.39%)	1,260 (2.31%)	1.034	0.956,1.118	0.4011
Chronic pancreatitis	492 (0.9%)	577 (1.06%)	0.851	0.754,0.961	0.0090
Necrotizing pancreatitis	36 (0.07%)	42 (0.08%)	0.857	0.549,1.338	0.4968
Pancreatic pseudocyst	196 (0.36%)	147 (0.27%)	1.335	1.077,1.653	0.0081
Pancreatic cyst	482 (0.88%)	328 (0.6%)	1.474	1.28,1.697	< 0.0001
Exocrine pancreatic insufficiency	107 (0.19%)	168 (0.31%)	0.636	0.499,0.811	0.0002
Benign neoplasm of the pancreas	34 (0.06%)	37 (0.07%)	0.919	0.577,1.464	0.7217
Pancreatic cancer	92 (0.17%)	168 (0.3%)	0.547	0.424,0.705	< 0.0001
Pancreatic Outcomes in UC on Biologics vs No Biologics
Outcome	UC on biologics N=29,573	UC not on biologics N=29,573	OR	95% CI	p-value
Acute pancreatitis	571 (1.93%)	535 (1.8%)	1.069	0.949,1.204	0.2745
Chronic pancreatitis	241 (0.82%)	303 (1.03%)	0.794	0.67,0.941	0.0076
Necrotizing pancreatitis	19 (0.06%)	25 (0.09%)	0.76	0.418,1.38	0.3655
Pancreatic pseudocyst	83 (0.28%)	101 (0.34%)	0.821	0.614,1.098	0.1838
Pancreatic cyst	269 (0.91%)	236 (0.8%)	1.141	0.957,1.36	0.1403
Exocrine pancreatic insufficiency	70 (0.23%)	106 (0.36%)	0.66	0.488,0.892	0.0066
Benign neoplasm of the pancreas	21 (0.07%)	20 (0.07%)	1.05	0.569,1.938	0.8759
Pancreatic cancer	49 (0.16%)	87 (0.29%)	0.562	0.396,0.799	0.0011

Table: Table: Pancreatic Outcomes in Crohn's Disease and Ulcerative Colitis on Biologics vs No Biologics

Disclosures:

Thabet Qapaja indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Osama Abu-Shawer indicated no relevant financial relationships.

Motasem Alkhayyat indicated no relevant financial relationships.

Almaza Albakri indicated no relevant financial relationships.

Serge Baroud indicated no relevant financial relationships.

Miguel Regueiro: AbbVie – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Alfasigma – Advisory Committee/Board Member, Consultant. Allergan – Advisory Committee/Board Member, Consultant. Amgen – Advisory Committee/Board Member, Consultant. Bristol Myers Squibb – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Celgene – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Eli Lilly – Advisory Committee/Board Member, Consultant. Genentech – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Gilead Sciences – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Janssen – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Miraca Labs – Advisory Committee/Board Member, Consultant. Pfizer Inc – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Prometheus – Advisory Committee/Board Member, Consultant. Salix – Advisory Committee/Board Member, Consultant. Seres – Advisory Committee/Board Member, Consultant. Takeda – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Target RWE – Advisory Committee/Board Member, Consultant. UCB – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Wolters Kluwer Health – Royalties.

Thabet Qapaja, MD¹, Khaled Alsabbagh Alchirazi, MD¹, Osama Abu-Shawer, MD, MS¹, Motasem Alkhayyat, MD¹, Almaza Albakri, MD², Serge Baroud, MD³, Miguel Regueiro, MD⁴. P0703 - Assessing the Risk of Pancreatic Diseases in Inflammatory Bowel Disease Patients on Biological Therapy: A Retrospective Cohort Study Using a Large Database, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.