POS0644 IMPACT OF FIBRE AND RED/PROCESSED MEAT INTAKE ON TREATMENT OUTCOMES AMONG PATIENTS WITH CHRONIC INFLAMMATORY DISEASES INITIATING BIOLOGICAL THERAPY: A PROSPECTIVE COHORT STUDY

Abstract

BackgroundCrohn’s disease (CD), Ulcerative Colitis (UC), Rheumatoid Arthritis (RA), Axial Spondyloarthritis (axSpA), Psoriatic Arthritis (PsA), and Psoriasis (PsO) are known as Chronic Inflammatory Diseases (CID). These CID’s are prevalent diseases that share pathophysiological pathways, genetics, environmental factors and pharmacological therapies. Biologic disease-modifying drugs have revolutionised the treatment of CIDs but unfortunately up to 60% of the patients have no or only suboptimal response to the treatment. Aside pharmacologic treatment, many patients are interested in self-management strategies for their symptoms and often request dietary recommendations. However, sound evidence for such recommendations is lacking [1].ObjectivesTo investigate if the treatment outcome of biological therapy (e.g. a TNF inhibitor) is associated with the habitual dietary intake of fibre and red/processed meat in patients with a CID [2].MethodsIn this prospective multicentre cohort study we consecutively enrolled 233 adult patients with a diagnosis of CD, UC, RA, axSpA, PsA or PsO for whom biologic therapy was planned. The Intention-to-Treat (ITT) population was defined as those with completed baseline food frequency questionnaires enabling stratification into a high fibre/low red and processed meat exposed group (HFLM) and an unexposed group (low fibre/high red and processed meat intake = LFHM). This was determined by the ratio of fibre to red/processed meat intake whereby HFLM constituted the upper tertile of the study sample and LFHM constituted the two lower tertiles of the study sample. The primary outcome was the proportion of patients with a clinical response to biologic therapy after 14-16 weeks of treatment. Based on the ITT population, differences between the dietary phenotypes in terms of the clinical response rate were analysed (while adjusting for the specific CID) in logistic regression models. Trial registration ClinicalTrials.gov NCT03173144.ResultsOf 193 patients included in the ITT population, we had outcome data on 176 (i.e. data from 17 patients were imputed): 114 (59%) had a clinical response to biologic therapy. In the HFLM group, 41 (64%) patients responded to treatment compared to 73 (56%) in the LFHM group, but the difference proved not to be statistically significant (Odds ratio, OR: 1.48, 95% confidence interval 0.72 to 3.05). For RA patients however, HFLM diet was associated with a clinical response in 82% compared to 28% in the LFHM group (OR: 9.84, 1.35 to 71.56). The same picture was seen for the ‘As Observed’ population (i.e. excluding the 17 patients without outcome data), see Figure 1. Changes in measures of health-related quality of life, physician’s global assessment and C-reactive protein were comparable between groups and across conditions.Figure 1.Meta-analysis (random effects model) of the included Chronic Inflammatory Diseases (CIDs) on the ‘As Observed’ population comparing clinical response to biologics in patients with a high intake of fibre and low intake of red/processed meat (HFLM) versus patients with a low intake of fibre and high intake of red/processed meat (LFHM). The horizontal lines represent the OR ± 95% CI. Event= clinical response according to the specified criteria for each CID.ConclusionOverall, habitual HFLM intake did not affect the clinical response to biological treatment across CIDs. However, a HFLM diet in RA patients might be associated with a better response following biological treatment.