Weston Bettner, MD1, Andrew Althouse, PhD2, Claudia Ramos Rivers, MD2, Marc Schwartz, MD1, Siobhan Proksell, MD1, Elyse Johnston, MD1, Arthur Barrie, MD, PhD1, Jana Al Hashash, MD1, Janet Harrison, MD1, Dmitriy Babichenko, PhD2, Gong Tang, PhD2, Ioannis Koutroubakis, MD, PhD1, David Binion, MD1
1University of Pittsburgh Medical Center, Pittsburgh, PA; 2University of Pittsburgh, Pittsburgh, PA
Introduction: Peripheral blood eosinophilia (PBE) has been recognized as a biomarker, identifying a subgroup of inflammatory bowel disease (IBD) patients with worse clinical outcomes. With more severe disease, anti-TNF therapy is often employed, with varied rates of success. The aim of this study was to determine whether the presence of pre-treatment PBE identifies IBD patients at risk for diminished anti-TNF treatment response.
Methods: We performed a registry analysis of IBD patients starting anti-TNF therapy who were enrolled in a consented, prospective, natural history IBD cohort at a tertiary center. Metadata was collected in the 2 years preceding and 2 years following anti-TNF initiation. The presence of PBE before and after anti-TNF initiation was recorded and treatment response was assessed for those with/without PBE using disease activity scores [Harvey Bradshaw Index (HBI) and Ulcerative Colitis Activity Index (UCAI)], quality of life measures [Short Inflammatory Bowel Disease Questionnaire (SIBDQ)], inflammatory markers (ESR, CRP), steroid use (prednisone or methylprednisolone), IBD-related hospitalizations, and IBD-related surgeries. Outcomes were assessed via linear mixed-effects and Cox proportional-hazards models for Crohn’s disease (CD) and ulcerative colitis (UC).
Results: A total of 580 IBD patients (CD 430, UC 150) were included with 111 (19%) demonstrating pre-treatment PBE (CD 66, UC 45). Table 1 summarizes demographic and clinical data. Following anti-TNF therapy, CD patients with pre-treatment PBE were more likely to have an IBD-related hospitalization [adjusted hazard ratio (AHR) 1.88, 95% CI 1.22-2.90, p=0.004] and require anal fistula repair (AHR 3.88, 95% CI 1.09-13.8, p=0.04) than CD patients without PBE. UC patients with pre-treatment PBE were more likely to have an elevated CRP following anti-TNF therapy (OR 2.77, 95% CI 1.50-5.10, p=0.001) with a non-significant trend towards increased IBD-related admissions and surgeries. CD patients with pre-treatment PBE were less likely to require steroids following anti-TNF therapy than CD patients without PBE (AHR 0.40, 95% CI 0.18-0.86, p=0.019). There was no significant difference in HBI, UCAI, or SIBDQ scores in patients with/without PBE undergoing anti-TNF therapy.
Discussion: Pre-treatment PBE identifies IBD patients at risk for worse outcomes following anti-TNF therapy, particularly in CD. Further studies are warranted to determine if alternate mechanism of action biologics will function optimally in the PBE IBD population.
Citation: Weston Bettner, MD; Andrew Althouse, PhD; Claudia Ramos Rivers, MD; Marc Schwartz, MD; Siobhan Proksell, MD; Elyse Johnston, MD; Arthur Barrie, MD, PhD; Jana Al Hashash, MD; Janet Harrison, MD; Dmitriy Babichenko, PhD; Gong Tang, PhD; Ioannis Koutroubakis, MD, PhD; David Binion, MD. P1390 - DEVELOPING PRECISION MEDICINE IN IBD: PERIPHERAL BLOOD EOSINOPHILIA IDENTIFIES INDIVIDUALS WITH WORSE OUTCOMES FOLLOWING INITIATION OF ANTI-TNF BIOLOGIC AGENTS. Program No. P1390. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.