S964 Impact of Biologics Therapy on the Prevalence of Erectile Dysfunction Among Patients With Inflammatory Bowel Disease: A Nationwide Population-Based Study

Abstract

Introduction: Erectile dysfunction (ED) is a well-established comorbidity of Inflammatory bowel disease (IBD). However, the connection between the two diseases remains unclear. Previous studies have suggested that chronic inflammation resulting in endothelial dysfunction maybe a contributing factor in the pathology of ED. Biologics have been shown to decrease inflammation among IBD patients. Therefore, we sought to investigate the prevalence of ED among individuals with IBD in a large national claims database and assess if biologics therapy may affect the risk of ED in patients with IBD. Methods: We used the IBM Explorys clinical database which includes over 74 million de-identified unique patients across 300 hospitals in the United States. Patients were identified using SNOMED and ICD codes. We identified all male patients (age >18 years) who were diagnosed with either Crohn’s disease (CD) or ulcerative colitis (UC). We investigated the prevalence of ED in IBD patients compared to patients with no IBD. Also, we compared the prevalence of ED between IBD patients with and without biologics therapy. Odds ratios with 95% confidence intervals were calculated to evaluate the risk of ED. Results: In this male-only cohort, we identified 100,020 patients with CD and 86,340 patients with UC, of whom 7,060 (7.06%) and 7,430 (8.61%) developed ED, respectively compared to 2.89% in individuals without IBD, p< 0.0001 to all. Both CD [OR: 2.54; 95% CI: 2.48-2.61] and UC [OR: 3.16; 95%CI: 3.08-3.23] patients had a significant higher risk of ED compared to patients without IBD. 20,040 (20.0%) patients with CD and 10,980 (12.7%) patients with UC received biologics therapy. The biologics-treated cohort was not significantly associated with a lower risk of developing ED in both CD [OR: 1.02; 95%CI: 0.96-1.09] and UC [OR: 0.99; 95%CI: 0.92-1.07], respectively (Figure). Conclusion: In this large retrospective study, we found that the prevalence of ED in patients with IBD was significantly higher than the general population. Overall, treatment with biologics was not associated with a significant decline in ED among IBD patients. These findings suggest that ED among patients with IBD may be driven by a different pathology besides chronic inflammation. Further studies are needed to determine the etiology behind ED among IBD patients.Figure 1.: Logistic Regression of Erectile Dysfunction Risk in IBD, IBD; inflammatory bowel disease. Immunomodulators included Azathioprine, Methotrexate and Mercaptopurine. Other biologics included Natalizumab, Ustekinumab and Vedolizumab. TNF-a Blockers; tumor necrosis factor-alpha blocker. Table 1. - Demographics of patients with IBD and ED Variable Patients with ED With IBD Without IBD No ED N 12,780 % 903,480 % 30532290 % Age 18 - 64 5,760 45.1% 434,850 48.1% 21,038,710 68.9% Age >65 7,070 55.3% 472,220 52.3% 9,126,770 29.9% Caucasian 10,640 83.3% 663,680 73.5% 16,599,190 54.4% Smoker 2,810 22.0% 151,670 16.8% 1,791,870 5.9% Alcohol abuse 980 7.7% 52,640 5.8% 674,360 2.2% T2DM 4,150 32.5% 270,010 29.9% 2,627,640 8.6% Hyperlipidemia 9,350 73.2% 639,150 70.7% 5,077,870 16.6% HTN 4,330 33.9% 255,660 28.3% 1,366,290 4.5% CAD 3,780 29.6% 196,350 21.7% 2,027,450 6.6% Depressive disorder 4,590 35.9% 213,260 23.6% 2,010,190 6.6% Colectomy 3,190 25.0% 89,640 9.9% 488,020 1.6% Small intestinal repair/resection 1,880 14.7% 16,560 1.8% 473,250 1.6% PDE5 inhibitor use 4,620 36.2% 337,800 37.4% 342,420 1.1% IBD; inflammatory bowel disease, ED; erectile dysfunction, T2DM; type 2 diabetes mellitus, HTN; essential hypertension, CAD; coronary artery disease, PDE5; phosphodiesterase type 5 inhibitor.