P0780 - The Impact of Obesity on Patients with Inflammatory Bowel Disease: A Nationwide Database 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, Abel Joseph, MD¹, Talal Sarmini, MD¹, Nour Azzouz, MD¹, Miguel Regueiro, MD²
¹Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH

Introduction: Obesity is common among individuals with inflammatory bowel disease (IBD), with studies suggesting a significant percentage (15-40%) of IBD patients being obese. It has been theorized that of the release of proinflammatory cytokines from adipocytes may lead to chronic inflammation and exacerbate IBD. The relationship between obesity, IBD outcomes, and treatment response remains unclear. Our study aimed to investigate the impact of obesity on IBD-related outcomes and medication utilization.

Methods: We used a large multi-institutional database named TriNetX, which aggregates over 106 million unique patients’ charts. We identified adults diagnosed with IBD Crohn’s disease (CD) or ulcerative colitis (UC) and obesity (BMI >35). We compared Obese IBD patients (case) to non-obese IBD patients (controls). We used 1:1 propensity score matching for age, gender, ethnicity and known co-morbid conditions like DM, heart disease, kidney disease, chronic liver disease, chronic respiratory disease, smoking, alcohol use, and malnutrition. Medication utilization and IBD outcomes like intestinal resection, obstruction, colectomy, colon cancer and C.diff infection were evaluated in obese IBD patients with and without biologics therapy. Adjusted odds ratios (aOR) with 95% confidence interval (CI) were calculated to express the risk of each outcome.

Results: Following matching, both CD cohorts had 21,817 patients, while both UC cohorts had 22,701 patients. Obese patients with either CD or UC were more likely to be treated with biologics and require steroids, Table 1. Obese patients with CD who received biologics were more likely to suffer from perianal fistula and abscess, intestinal fistula, intestinal resection, colectomy and C.diff infection when compared with those not on biologics. Similarly, obese patients with UC who received biologics were more likely to colectomy and C.diff infection. Interestingly, biologics treated obese patients with CD had lower odds of having colon cancer when compared with those not on biologics but there was no significant difference in colon cancer among UC cohorts. Figure 1, Panel A&B.

Discussion: This is one of the largest studies investigating the outcomes of IBD in obese patients. Our findings suggest that obese individuals with IBD were more likely to be on biologics compared to non-obese patients with IBD and have more disease related complications Whether obesity manifests a different phenotype of IBD and requires a modified treatment approach is not clear.

Figure: Figure 1: Odds of IBD related complications in biologics treated obese patients with IBD compared to obese patients with IBD not on biologics after propensity score matching. Panel A represents Crohn's disease (CD) outcomes & Panel B represents ulcerative colitis (UC) outcomes.

Medication	Obese with CD (n=21,817)	Non obese with CD (n=21,817)	aOR (95% CI)	P-value
Biologics	5,204	4,885	1.09 (1.04-1.14)	< 0.001
Adalimumab	2,2275	21,61	1.06 (0.99-1.13)	0.071
Certolizumab	390	332	1.18 (1.02-1.37)	0.030
Infliximab	2,184	1,729	1.29 (1.21-1.38)	< 0.001
Golimumab	67	53	1.27 (0.88-1.81)	0.201
Vedolizumab	926	873	1.06 (0.97-1.17)	0.202
Ustekinumab	1,375	1,353	1.02 (0.94-1.09)	0.664
Natalizumab	36	20	1.80 (1.04-3.11)	0.032
Tofacitinib	110	77	1.43 (1.07-1.92)	0.016
MTX	1,203	917	1.33 (1.22-1.45)	< 0.001
Azathioprine	2,164	1,698	1.31 (1.22-1.39)	< 0.001
Mercaptopurine	815	716	1.14 (1.03-1.27)	0.010
Prednisone	8,284	6,159	1.56 (1.50-1.62)	< 0.001
Methylprednisone	5,899	4,863	1.29 (1.24-1.35)	0.001
Medication	Obese with UC (n=22,701)	Non obese with UC (n=22,701)	aOR (95% CI)	P-value
Biologics	3,354	2,987	1.14 (1.09-1.21)	< 0.001
Adalimumab	1,304	1,099	1.19 (1.103-1.301)	< 0.001
Certolizumab	142	95	1.50 (1.15-1.94)	0.002
Infliximab	1,462	1,165	1.27 (1.18-1.38)	< 0.001
Golimumab	90	93	0.97 (0.72-1.29)	0.824
Vedolizumab	914	878	1.04 (0.95-1.15)	0.386
Ustekinumab	683	607	1.12 (1.01-1.26)	0.032
Natalizumab	18	11	1.63 (0.77-3.46)	0.194
Tofacitinib	193	202	0.96 (0.78-1.16)	0.649
MTX	818	539	1.54 (1.38-1.72)	< 0.001
Azathioprine	1,530	1,208	1.29 (1.19-1.39)	< 0.001
Mercaptopurine	611	467	1.31 (1.17-1.49)	< 0.001
Prednisone	8,288	6,232	1.52 (1.46-1.58)	< 0.001
Methylprednisone	5,624	4,804	1.23 (1.17-1.28)	< 0.001

Table: Table 1: IBD medication utilization in obese vs non-obese IBD patients after propensity score matching. Abbreviations: aOR: adjusted odds ratio; CI: confidence interval; CD: Crohn's disease; UC: ulcerative colitis; MTX: Methotrexate.

Disclosures:

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Thabet Qapaja indicated no relevant financial relationships.

Osama Hamid indicated no relevant financial relationships.

Abel Joseph indicated no relevant financial relationships.

Talal Sarmini indicated no relevant financial relationships.

Nour Azzouz 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, Abel Joseph, MD¹, Talal Sarmini, MD¹, Nour Azzouz, MD¹, Miguel Regueiro, MD². P0780 - The Impact of Obesity on Patients with Inflammatory Bowel Disease: A Nationwide Database Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.