P0782 - Disease Burden and Outcomes of IBD in Psoriatic Patients: A Population-Level Cohort Study

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Khaled Alsabbagh Alchirazi, MD

Cleveland Clinic
Cleveland, OH

Khaled Alsabbagh Alchirazi, MD¹, Thabet Qapaja, MD¹, Osama Hamid, MD, MRCPI¹, Prabhat Kumar, MD², Muaz Alsabbagh, MD¹, Miguel Regueiro, MD³
¹Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH

Introduction: Inflammatory bowel disease (IBD) is a chronic inflammatory condition affecting the gastrointestinal tract. Psoriasis is a chronic skin disorder characterized by red, scaly patches resulting from an overactive immune system. Despite involving distinct organ systems, IBD and psoriasis demonstrate a complex relationship due to shared underlying immunological and genetic factors. Studies have revealed a higher prevalence of psoriasis in individuals with IBD, and vice versa, compared to the general population. Using a large database, we sought to describe the clinical outcomes of IBD among patients with psoriasis.

Methods: We used a large multi-institutional database named TriNetX, which aggregates over 100 million unique patients’ charts. We identified adults diagnosed with IBD and psoriasis. We compared IBD patients with concomitant diagnosis of psoriasis (cases) to IBD patients without psoriasis (controls). We used 1:1 propensity score matching for age, gender, ethnicity, IBD subtype & phenotype, prior IBD related surgery and known co-morbid conditions like obesity, DM2, CKD, chronic liver disease, COPD, malnutrition, and IBD medications. Outcomes like IBD relapse, intestinal resection, obstruction & abdominal abscess were evaluated. Adjusted odds ratios (aOR) with 95% confidence interval (CI) were calculated to express the risk of each outcome.

Results: After propensity matching, both cohorts of UC with psoriasis (6,573) and CD with psoriasis (7,741) were matched with the non-psoriatic group. Our results found that patients with UC and CD in the psoriasis group have a higher prevalence of hepatic manifestations, including NAFLD and autoimmune hepatitis (p<0.001). Results were also significant for extraintestinal manifestations (EIM), including pyoderma gangrenosum (p<0.001), arthropathy, and ocular manifestations like episcleritis and uveitis. We also found that IBD-related complications’ risk including perianal fistula, abscess, and obstruction were significantly higher in the psoriatic group. Figure 1, Panel A&B.

Discussion: In this large national database study, we observed that patients with psoriasis tended to have a more severe IBD course as well as EIMs. Whether this is due to a systemic immune mediated event is not known but could suggest a need for earlier advanced therapies in these patients.

Figure: Figure 1: Odds of IBD outcomes in patients with psoriasis after propensity score matching. Panel A: outcomes of CD; Panel B: Outcomes of UC. Abbreviations: OR: Odds ratio; CI: Confidence interval; CD: Crohn's disease; UC: ulcerative colitis; NAFLD: Nonalcoholic fatty liver disease.

IBD related outcomes:	CD with psoriasis (n=7,741)	CD without psoriasis (n=7,741)	aOR (95% CI)	P-value
Perianal abscess:	428	244	1.80 (1.53-2.11)	< 0.001
Perianal fistula:	791	423	1.87 (1.67-2.10)	< 0.001
Obstruction	104	79	1.32 (0.98-1.77)	0.063
Intestinal Fistula:	412	218	1.94 (1.64-2.29)	< 0.001
Intestinal resection	1564	1121	1.49 (1.38-1.63)	< 0.001
C.diff	441	315	1.42 (1.23-1.65)	< 0.001
Colon cancer:	83	84	0.99 (0.73-1.34)	0.0938
Uveitis	193	77	2.51 (1.93-3.26)	< 0.001
Episcleritis	71	21	3.40 (2.09-5.54)	< 0.001
Arthropathy	508	203	2.61 (2.21-3.08)	< 0.001
Pyoderma gangrenosum	116	56	2.09 (1.52-2.88)	< 0.001
NAFLD	836	473	1.86 (1.65-2.09)	< 0.001
Vit D deficiency	2451	1407	2.09 (1.94-2.25)	< 0.001
Osteoporosis	833	491	1.78 (1.59-2.00)	< 0.001

Table: Table 1: Odds of Crohn’s disease outcomes in patients with psoriasis after propensity score matching.

Disclosures:

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Thabet Qapaja indicated no relevant financial relationships.

Osama Hamid indicated no relevant financial relationships.

Prabhat Kumar indicated no relevant financial relationships.

Muaz Alsabbagh 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.

Khaled Alsabbagh Alchirazi, MD¹, Thabet Qapaja, MD¹, Osama Hamid, MD, MRCPI¹, Prabhat Kumar, MD², Muaz Alsabbagh, MD¹, Miguel Regueiro, MD³. P0782 - Disease Burden and Outcomes of IBD in Psoriatic Patients: A Population-Level Cohort Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.