P0715 - Outpatient Biologic Therapy Is Associated With Worse Outcomes During and After Admissions for Acute Severe Ulcerative Colitis

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Yalda Dehghan, MD

McGaw Medical Center of Northwestern University
Chicago, IL

Yalda Dehghan, MD¹, Stephen B.. Hanauer, MD, FACG²
¹McGaw Medical Center of Northwestern University, Chicago, IL; ²Northwestern University Feinberg School of Medicine, Chicago, IL

Introduction: Acute severe ulcerative colitis (ASUC) requires hospitalization for urgent management. First-line medical therapy consists of IV corticosteroids; second-line therapy consists of either cyclosporine or infliximab. Colectomy is indicated when second-line medical therapy fails or in the event of an acute complication. As tumor necrosis factor (TNF) inhibitors and other biologic agents are increasingly utilized in outpatient settings, it is unclear how these will impact patient response to conventional and second-line medical management of ASUC. In this retrospective review, we identified patients admitted for ASUC and assessed initial and 1-year colectomy rates based on prior biologic exposure.

Methods: Patients with ASUC flares admitted to Northwestern Memorial Hospital between October 2014 and October 2022 were identified. Age, sex, disease extent/duration, admission dates, and prior outpatient therapies were obtained. Inpatient notes were reviewed to identify therapies used to treat ASUC (steroids, biologic agents, or cyclosporine), and whether colectomy was required during admission. Admissions for subsequent colectomy and readmissions (for a flare or other complications) within 1 year of initial ASUC flare were also identified. Outcomes were assessed based on whether there was exposure to biologic agents prior to admission. Odds ratios and chi-square tests were used to determine differences in rates of colectomy and readmissions; t-tests were used to identify differences in length of stay.

Results: Of 204 patients identified, 73 had been treated with a biologic agent prior to admission (44/73 were treated with infliximab). 30% of patients in the biologic group required inpatient colectomy compared to 13% of patients in the non-biologic group (Table 1). 52% of patients in the biologic group required a colectomy within 1 year of admission compared to 21% of those in the non-biologic group (p < 0.05). Length of stay did not significantly differ between the two cohorts.

Discussion: Patients treated with biologics as outpatients prior to an ASUC flare had significantly higher rates of medically refractory UC requiring inpatient colectomy or colectomy within 1 year of the initial ASUC admission. Patients in the biologic cohort also exhibited significantly higher rates of readmissions for flares or other complications.

	No Outpatient Biologics Prior to Admission	Outpatient Biologics Prior to Admission	Odds Ratio	Confidence Interval	p-value
Flare responsive to IV steroids alone	44.27%	30.14%	0.54	(0.30, 1.00)	< 0.05
Required inpatient colectomy	13.00%	30.14%	2.89	(1.42, 5.91)	< 0.05
Colectomy within 1 year of ASUC admission	20.61%	52.05%	4.18	(2.24, 7.81)	< 0.05
Readmitted within 1 year of ASUC admission	25.19%	41.10%	2.07	(1.12, 3.82)	< 0.05
Mean length of stay	11.03 (days)	10.84 (days)			0.86
	No Outpatient Infliximab Prior to Admission	Outpatient Infliximab Prior to Admission
Flare responsive to IV steroids alone	40.63%	34.09%	0.76	(0.38, 1.52)	0.43
Required inpatient colectomy	13.75%	38.64%	3.95	(1.86, 8.41)	< 0.05
Colectomy within 1 year of ASUC admission	23.75%	59.09%	4.64	(2.3, 9.36)	< 0.05
Readmitted within 1 year of ASUC admission	29.38%	38.64%	1.51	(0.75, 3.04)	0.24
Mean length of stay	10.86 (days)	11.32 (days)			0.73

Disclosures:

Yalda Dehghan indicated no relevant financial relationships.

Stephen Hanauer: AbbVie – Consultant, Speakers Bureau. Allergan – Advisor or Review Panel Member, Consultant. Amgen – Consultant. arena – Advisor or Review Panel Member, Consultant. BMS – Advisor or Review Panel Member, Consultant, Speakers Bureau. Boehringer Ingelheim – Consultant, participating in Data and Safety Monitoring Boards. Celgene – Consultant. Celltrion – Consultant. Fresenius Kabi – Consultant. Genentech – Consultant, Grant/Research Support. Gilead – Consultant, Grant/Research Support. Gossamer – Advisor or Review Panel Member. GSK – Consultant, Grant/Research Support. InDex – Advisor or Review Panel Member. Intercept – Advisor or Review Panel Member. Janssen – Consultant, Speakers Bureau. Lilly – Consultant, Speakers Bureau. Merck – Consultant. Morphic – Consultant. Novartis – Consultant. Pfizer – Consultant, Speakers Bureau. Progenity – Consultant. Prometheus – Advisor or Review Panel Member, Consultant, Grant/Research Support. Protagonist – Advisor or Review Panel Member, Consultant. Salix – Consultant. Samsung Bioepis – Consultant. Seres – Consultant. Takeda – Consultant, Grant/Research Support, Speakers Bureau. TTL Pharma – Consultant. Ventyx – Advisor or Review Panel Member.

Yalda Dehghan, MD¹, Stephen B.. Hanauer, MD, FACG². P0715 - Outpatient Biologic Therapy Is Associated With Worse Outcomes During and After Admissions for Acute Severe Ulcerative Colitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.