S0702 Crohn's Disease Patients Treated With Anti-TNFs Have Lower Rates of Bronchiectasis

Abstract

INTRODUCTION: Extraintestinal manifestations of Crohn's disease (CD) include pulmonary diseases. Bronchiectasis is the most commonly reported form of airway disease, but there are limited data on the effects of inflammatory bowel disease (IBD) treatment. Using a large database, we sought to describe the risk of bronchiectasis in CD patients and the effect of different IBD treatments. METHODS: We queried a multi-institutional database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 US healthcare systems. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of “Crohn's disease” between 2016 and 2020 was identified. Subsequently, a cohort of patients of new diagnosis of “bronchiectasis” after 30 days of “Crohn's disease.” Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp). For all analyses, a 2-sided P value of < 0.05 was considered statistically significant. RESULTS: Of the 39,328,760 individuals in the database, 181,670 had CD (0.46%). CD patients were 38.9% males, 80.4% Caucasian, and 71.1% in 18–65 years age group. The prevalence of patients with new diagnosis of bronchiectasis after at least 30 days of CD was 0.61% compared to 0.24% in the general population, P < 0.0001. Compared to the general population, patients with CD had higher association risk of bronchiectasis diagnosis [OR: 3.53; 95% CI: 3.36–3.82, P < 0.0001]. Among CD, predictors of having bronchiectasis included being elderly (>65 year old), female, Caucasian, and smokers [OR: 1.79; 95% CI: 1.61–2.01, P < 0.0001]. CD patients treated with anti-TNFs had lower rates of bronchiectasis [OR: 0.81; 95% CI: 0.70–0.93, P = 0.0027] whereas thiopurines had no significant effect [OR: 1.11; 95% CI: 0.97–1.28, P = 0.1347] and 5ASAs, methotrexate had higher rates compared to other treatments [OR: 1.18; 95% CI: 1.05–1.32, P = 0.0042] and [OR: 2.02; 95% CI: 1.69–2.42, P < 0.0001] respectively (Table 1). CONCLUSION: In this large database, we found a higher risk association between CD and bronchiectasis. CD patients who received anti-TNFs had lower rates of bronchiectasis. More data are needed, but it is possible that bronchiectasis is a TNF mediated extraintestinal manifestation and that anti-TNFs are protective.Table 1