Outcomes Of IBD Patients Research Articles

S1404 Janus Kinase Inhibitors Do Not Impact Male Sexual Health or Fertility Outcomes in IBD Patients

S1404 Janus Kinase Inhibitors Do Not Impact Male Sexual Health or Fertility Outcomes in IBD Patients

S1413 Impact of Race on Clinical Outcomes in IBD Patients on Anti-TNF Monotherapy and Anti-TNF Combination Therapy With Immunomodulators: A Propensity-Matched Cohort Study

S1413 Impact of Race on Clinical Outcomes in IBD Patients on Anti-TNF Monotherapy and Anti-TNF Combination Therapy With Immunomodulators: A Propensity-Matched Cohort Study

EFFECTS OF NUTRITION STATUS AND PERIOPERATIVE NUTRITION SUPPLEMENT COMPLETION ON POSTOPERATIVE OUTCOMES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE UNDERGOING SURGERY

Abstract BACKGROUND Malnutrition is common in inflammatory bowel disease, (IBD) and is associated with poor disease activity, greater hospital length of stay (LOS), higher 30-day readmission rates, and increased risk of postoperative complications. Structured, multimodal prehabilitation including nutrition counseling improves various outcomes after elective cancer and orthopedic surgeries. We examined the effects of malnutrition and perioperative nutrition supplementation on surgical outcomes in IBD patients participating in a multimodal prehabilitation program. METHODS This was a retrospective study of patients aged 18-80 enrolled in a 10-week prehabilitation program undergoing surgery for IBD. Beginning 4 weeks prior to surgery, patients met with a multidisciplinary team including a nurse practitioner, physical therapist and registered dietitian. Patients were provided 3 preoperative carbohydrate loading oral nutrition supplements (ONS) 48 hours prior to surgery, and 20 perioperative immunonutrition ONS. Malnutrition was defined using the Global Leadership in Malnutrition criteria as moderate or severe. We used Fisher’s exact test to determine associations between malnutrition, ONS use, and postoperative complications (defined by the comprehensive complication index (CCI, with CCI scores >20 classified as severe)), and 30-day readmission. Logistic and linear regression were used to analyze length of stay (LOS), opioid use (defined as morphine milligram equivalents, MME), nutrition status, and ONS completion. RESULTS 25 patients (48% female, mean age 44, 18 (72%) with Crohn’s disease) completed the prehabilitation program between 05/2022 and 10/2023. 10 patients (40%) met criteria for malnutrition (of these, 50% were moderate and 50% severe). Malnutrition was not significantly associated with CCI severity (p=0.07), LOS (p =0.07), opioid use (p=0.07) or 30 day readmission rates (0.06). Higher ONS use for carbohydrate loading and immunonutrition were more likely to have a LOS<5 days (p=0.05 and p=0.03 respectively). CONCLUSION ONS for preoperative carbohydrate loading and perioperative immunonutrition may shorten LOS after surgery among patients with IBD. In our study, higher amounts of ONS consumption led to a shorter LOS. Larger, controlled studies will help to further clarify the effects of malnutrition, carbohydrate loading, and immunonutrition among patients with IBD preparing for surgery.

S80 Effectiveness and Safety Outcomes in IBD Patients Over the Age of 60 Treated With Biologic or Small Molecule Therapies

S80 Effectiveness and Safety Outcomes in IBD Patients Over the Age of 60 Treated With Biologic or Small Molecule Therapies

Higher Serum Infliximab Concentrations Following Subcutaneous Dosing are Associated with Deep Remission in Patients with Inflammatory Bowel Disease

Abstract Background The relationship between subcutaneous infliximab [SC-IFX] concentrations and favourable therapeutic outcomes in patients with Crohn’s disease [CD] and ulcerative colitis [UC] remains elusive. Patients and Methods This cross-sectional study included consecutive adult patients with inflammatory bowel disease [IBD] treated with SC-IFX at a maintenance dose of 120 mg/2 weeks. Investigated therapeutic outcomes included sustained clinical remission; composite clinical and biomarker remission [clinical remission and C-reactive protein <5 mg/L]; biochemical remission [faecal calprotectin <250 µg/g]; and deep remission [clinical, biological, and biochemical remission]. Results Of 91 patients identified, 71 qualified for inclusion in the study [70% with CD; 27% with concomitant immunomodulators]. At the time of drug concentration measurement [median 13.5 months after switch], 55 [77%] patients had sustained clinical remission; n = 44 [62%] composite clinical and biomarker remission; n = 40 [56%] biochemical remission; and n = 31 [43%] deep remission. The mean SC-IFX concentrations were significantly higher in patients with sustained clinical remission [p = 0.014]; composite clinical and biomarker remission [p = 0.003]; biochemical remission [p < 0.001]; and deep remission [p < 0.001] compared to patients without having these outcomes. In multivariate analysis, SC-IFX concentration was the only factor independently associated with sustained clinical remission (odds ratio [OR]: 4.7, 95% confidence interval [CI]: 3.1–12.2, p = 0.005); clinical and biomarker remission [OR: 9.21, 95% CI: 6.09–18.7, p = 0.006]; biochemical remission [OR: 37, 95% CI: 14–39.3, p < 0.001]; and deep remission [OR: 29, 95% CI: 15.7–37.4, p < 0.001]. The optimal SC-IFX concentration cut-off associated with deep remission based on ROC analysis was 20 µg/mL [sensitivity: 0.91, specificity: 0.80, accuracy: 0.85]. Combination with an immunomodulator failed to improve SC-IFX pharmacokinetics. Conclusion Higher SC-IFX concentrations are associated with higher rates of favourable therapeutic outcomes in IBD patients. Serum SC-IFX concentrations >20 µg/mL were significantly associated with deep remission.

S1000 Exploring the Influence of COVID-19 Treatment on Real-World Outcomes in IBD Patients: A Comprehensive Analysis

S1000 Exploring the Influence of COVID-19 Treatment on Real-World Outcomes in IBD Patients: A Comprehensive Analysis

Endoscopic retrograde cholangiopancreatography outcomes in inflammatory bowel disease patients: a 12-year analysis of a national database

Despite inflammatory bowel disease's (IBD) association with hepatobiliary disorders and the use of endoscopic retrograde cholangiopancreatography (ERCP) for both diagnostic and therapeutic evaluation of these diseases, it remains a poorly studied area within the literature. The purpose of this study is to examine the effect of IBD on the occurrence of adverse events (AE) pertaining to ERCP.This project utilized the National Inpatient Sample (NIS) database, the largest inpatient database in the USA. All patients 18 years or older with and without IBD undergoing ERCP were identified from 2008 to 2019. Post-ERCP AEs were analyzed using multivariate logistic or linear regression controlling for age, race, and existing comorbidities using the Charlson comorbidity index (CCI).There was no difference in post-ERCP pancreatitis (PEP) or mortality. IBD patients were also found to have a lower risk of bleeding and decreased length of stay (LOS) despite adjustment for comorbidities. They also underwent less sphincterotomies when compared to the non-IBD cohort. Subgroup analysis between ulcerative colitis (UC) and Crohn's disease (CD) did not find any significant differences in outcomes.To our knowledge, this is the largest study to date evaluating ERCP outcomes in IBD patients. After adjustment of co-variates, there was no difference in the occurrence of PEP, infections, and perforation. IBD patients were less likely to experience post-ERCP bleeding and mortality and had shorter LOS which may be due to the decreased frequency of sphincterotomy in this population.

Influence of diabetes mellitus on inflammatory bowel disease course and treatment outcomes. A systematic review with meta-analysis.

Diabetes Mellitus (DM) may occur in IBD and influence the disease progression. To compare disease course and treatment outcomes in IBD patients with and without DM. This is a systematic review with meta-analysis comparing patients with IBD plus DM with patients with IBD only. need for surgery, IBD-related complications, hospitalizations, sepsis, mortality. Quality of life and costs were assessed. Five studies with 71,216 patients (49.1% with DM) were included. Risk for IBD-related complications (OR=1.12, I2 98% p=0.77), mortality (OR=1.52, I2 98% p=0.37) and IBD-related surgery (OR=1.20, I2 81% p=0.26) did not differ. Risk of IBD-related hospitalizations (OR=2.52, I2 0% p<0.00001) and sepsis (OR=1.56, I2 88% p=0.0003) was higher in the IBD+DM group. Risk of pneumonia and urinary tract infections was higher in the IBD+DM group (OR=1.72 and OR=1.93), while risk of C. Difficile infection did not differ (OR=1.22 I2 88% p=0.37). Mean Short Inflammatory Bowel Disease Questionnaire score was lower in the IBD+DM group (38.9vs. 47, p=0.03). Mean health care costs per year were $10,598.2 vs $3747.3 (p<0.001). DM might negatively affect the course of IBD by increasing the risk of hospitalization and infections, but not IBD-related complications and mortality.

P144 Impact of major medication discontinuation during the first wave of COVID-19 pandemic on the risk of early relapse in patients with inflammatory bowel disease: a French observational retrospective study

Abstract Background The prevalence of nonadherence to major treatments and the subsequent adverse outcomes in IBD patients during the first wave of COVID-19 pandemic remain scarce. Aim to investigate the risk of early disease relapse in a cohort of IBD patients under immunosuppressants and/or biologics who decided themselves to discontinue their IBD-related major treatments without previous medical advice during the first wave of COVID-19 pandemic. Methods All consecutive patients with inactive IBD under immunosuppressants and/or biologics who acknowledged having withdrawn their major therapy for IBD without previous medical advice during the first wave of COVID-19 (from March 2020 to December 2020) were enrolled. The primary endpoint was the survival rate without disease relapse. Kaplan-Meier curves were plotted for time from inclusion to IBD relapse and a logistic regression model with uni- and multivariate analyses was performed to identify predictors of relapse after drug discontinuation. Results During the study period, among the 862 IBD patients followed as outpatients either treated with infliximab or vedolizumab (outpatient clinics n= 368) or treated with oral azathioprine, adalimumab, golimumab or ustekinumab alone or in combination (n= 494), 54 patients (6.2 %) (42 CD, 12 UC, 28 F, median age 36 years) who had discontinued themselves their IBD-related major therapy without previous medical advice were included. The median duration of drug withdrawal was 7.0 weeks (range 2-24) and the median time to relapse was 9.0 weeks (range 4-20). The most treatments withdrawn were adalimumab (n=19), ustekinumab (n=19), azathioprine (n= 12), golimumab (n=1) and a lesser degree infliximab (n=7) eand vedolizumab (n=6). During the median follow-up period of 24 weeks (range 5-42), 22 out of 54 patients (40.7 %) who discontinued their IBD treatment experienced a relapse in whom 6 requiring administration of oral steroids, 4 hospitalization and 2 IBD-related surgery. By univariate analysis, past IBD related surgery was identified as the only predictor of disease relapse after drug withdrawal (OR=3.3 CI 95 % [1.08-10.38]. Conclusion In IBD patients, major treatment discontinuation by the patients themselves without medical advices during the first wave of pandemic Covid-19 including the lockdown was associated with a substantial risk of disease relapse occurring in around 4 out of 10 patients and subsequent further risk of need for steroids, hospitalization and surgery. Strategies targeting the adherence to therapy and patient’s informations about the real risks leading to drug discontinuation are of paramount interest, especially during health crisis to minimize such issues.

Adherence to Objective Therapeutic Monitoring and Outcomes in Patients with Inflammatory Bowel Disease with Adalimumab Treatment. A Real-world Prospective Study

Objective monitoring and effective early treatment using a treat-to-target approach are key to improving therapeutic outcomes in IBD patients. This study aimed to assess adherence to objective monitoring (clinical, biomarkers, and endoscopy) and its impact on clinical outcomes. A prospective, multicenter study included consecutive IBD patients starting on adalimumab therapy between January 2019 and December 2020. Disease activity, assessed by the Harvey-Bradshaw index (HBI), partial Mayo, C-reactive protein (CRP), fecal calprotectin (FCAL), and endoscopy were evaluated at adalimumab initiation and 3, 6, 9 and 12 months. Therapeutic drug monitoring, changes in treatment, drug sustainability, and clinical outcomes were assessed. 104 IBD patients were enrolled (78.8% CD, median age 34.3 years, disease duration 9 years). During the 12 months follow-up, high adherence to clinical activity assessment was observed in both CD (81.3%- 87.7%) and UC patients (76.5-90.9%). CRP measurement decreased over time in both CD (37.3%-54.9%) and UC (29.4%-50.0%). The adherence to serial FCAL monitoring was low in CD (22.7-31.3%) and UC patients (17.6-56.0%). UC patients had higher adherence to early endoscopic assessment (<6 months) compared to CD patients (40.9% vs. 21.5%). Adherence to early combined clinical and biomarkers resulted in earlier dose optimization in CD and UC (log-rank<0.001), but drug sustainability was not different. The patients with early combined adherence had a significantly higher clinical remission rate at 1 year compared to non-adherence (70.2% vs. 29.8%, p=0.007) but no significant difference in UC patients. The adherence to early objective monitoring with combined clinical and biomarkers assessment in IBD patients starting adalimumab therapy led to dose optimization and improved 1-year clinical remission in CD but did not change drug sustainability and clinical remission in UC.

S719 Maternal and Neonatal Outcomes in Vedolizumab and Ustekinumab Exposed Pregnancies: Results From the PIANO Registry

Introduction: Pregnancy outcomes in IBD patients with quiescent disease are similar to the general population. Data from the Pregnancy Inflammatory bowel disease And Neonatal Outcomes (PIANO) registry have demonstrated the safety of anti-tumor necrosis factor alpha (TNFs) and thiopurines in pregnancy. The objective of this study is to provide updated information from the PIANO registry on maternal and fetal outcomes in patients exposed to ustekinumab (UST) and vedolizumab (VDZ). Methods: In this multicenter prospective observational study, we included pregnant women with singleton pregnancies and a diagnosis of inflammatory bowel disease. Questionnaires were administered to women at study intake, each subsequent trimester, delivery, and at 4, 9, and 12 months after birth. Bivariate analyses were utilized to determine the independent effects of specific drug classes on outcomes. The exposure cohorts were VDZ, UST, TNFs, immunomodulators, and combination with biologics and immunomodulators. All were compared to no exposure to biologics/immunomodulators. Results: There were 1642 completed pregnancies with 1581 live births. Maternal mean age was 32.1±4.6 years at delivery with 62 VDZ and 43 UST exposed. Women on UST were more likely to have Crohn’s disease. There was no increased risk of spontaneous abortion, small for gestational age, low birth weight, neonatal intensive care unit stay, congenital malformations, or intrauterine growth restriction with in utero VDZ or UST exposure (Table). The rate of preterm birth was 0% in UST, 12.7% VDZ, 8.2% TNFs, and 9.7% in the unexposed cohort (p = 0.037). Rates of serious and non-serious infections at birth and within the first 12 months of life were comparable among all groups, with an increase in nonserious infections in VDZ group at 4 months, which did not persist at 1 year. There was no increased risk of placental complications in the VDZ cohort compared to the unexposed cohort. UST infant concentrations at birth were increased whereas VDZ concentrations were overall decreased compared to maternal serum drug concentrations. Conclusion: An updated analysis of UST and VDZ exposure during pregnancy suggests no increase in complications compared to TNFs, immunomodulators and combination of biologics with immunomodulators. UST was associated with lower rates of preterm birth and Cesarean section. No signal was found for increased placental events with either therapy. Continuation of UST and VDZ during pregnancy is recommended. Table 1. - Pregnancy Related Complications by Drug Exposure in completed pregnancies Pregnancy Events(% yes) No exposure(n = 430) Anti-TNFs(n = 700) Immuno-modulators(n = 226) Combination: Biologics + Immunomodulators(n = 179) UST(n = 43) VDZ(n = 62) p-value Any pregnancy complication 86/401(21.4%) 123/649(19.0%) 42/208(20.2%) 28/169(16.6%) 10/39(25.6%) 10/59(16.9%) 0.663 SAB (gestation ages ≤140 days) 9/234(3.8%) 18/438(4.1%) 6/136(4.4%) 2/109(1.8%) 2/21(9.5%) 1/30(3.3%) 0.675 SAB (all gestation ages) 11/429(2.6%) 18/697(2.6%) 7/226(3.1%) 2/178(1.1%) 2/43(4.7%) 1/62(1.6%) 0.739 Preterm birth (< 37 weeks) 38/391(9.7%) 53/643(8.2%) 25/204(12.3%) 24/166(14.5%) 0/38(0.0%) 7/55(12.7%) 0.037 Small for gestational age 16/383(4.2%) 31/579(5.4%) 5/202(2.5%) 3/147(2.0%) 1/14(7.1%) 2/35(5.7%) 0.356 LBW (< 2500 g) 21/380(5.5%) 38/635(6.0%) 9/206(4.4%) 8/159(5.0%) 1/38(2.6%) 6/55(10.9%) 0.493 Intrauterine growth restriction 11/429(2.6%) 13/700(1.9%) 1/226(0.4%) 4/179(2.2%) 0/43(0.0%) 1/62(1.6%) 0.455 Cesarean section 154/394(39.1%) 292/650(44.9%) 93/208(44.7%) 90/168(53.6%) 12/38(31.6%) 26/55(47.3%) 0.024 NICU at birth 58/397(14.6%) 107/651(16.4%) 31/209(14.8%) 29/168(17.3%) 4/37(10.8%) 8/55(14.5%) 0.879 Congenital malformations 28/268(10.4%) 61/581(10.5%) 19/150(12.7%) 18/153(11.8%) 7/39(17.9%) 8/59(13.6%) 0.715 Any of the above 275/430(64.0%) 477/700(68.1%) 156/226(69.0%) 128/179(71.5%) 28/43(65.1%) 42/62(67.7%) 0.513 Abruptio Placenta 3/198(1.5%) 5/302(1.7%) 1/93(1.1%) 1/75(1.3%) 0/13(0.0%) 0/31(0.0%) >0.999 Pre-Eclampsia/Eclampsia 18/198(9.1%) 30/302(9.9%) 13/93(14.0%) 7/75(9.3%) 2/13(15.4%) 4/31(12.9%) 0.512 Placenta previa 5/197(2.5%) 9/302(3.0%) 2/93(2.2%) 1/75(1.3%) 0/13(0.0%) 2/31(6.5%) 0.243 Hemorrhage 5/197(2.5%) 5/302(1.7%) 5/93(5.4%) 2/75(2.7%) 3/13(23.1%) 0/31(0.0%) >0.999 Postpartum hemorrhage 6/197(3.1%) 15/302(2.1%) 1/93(1.1%) 5/75(6.7%) 0/13(0.0%) 1/31(3.2%) >0.999 TNF: tumor necrosis factor, UST: ustekinumab, VDZ: vedolizumab, SAB: spontaneous abortion, LBW: low birth weight, g: grams, NICU: neonatal intensive care unit, vs: versus.

ECCO Topical Review: Roadmap to Optimal Peri-Operative Care in IBD.

Despite the advances in medical therapies, a significant proportion of patients with inflammatory bowel diseases [IBD] require surgical intervention. This Topical Review aims to offer expert consensus practice recommendations for peri-operative care to optimize outcomes of IBD patients who undergo surgery. A multidisciplinary panel of IBD healthcare providers systematically reviewed aspects relevant to peri-operative care in IBD. Consensus statements were developed using Delphi methodology. A total of 20 current practice positions were developed following systematic review of the current literature covering use of medication in the peri-operative period, nutritional assessment and intervention, physical and psychological rehabilitation and prehabilitation, and immediate postoperative care. Peri-operative planning and optimization of the patient are imperative to ensure favourable outcomes and reduced morbidity. This Topical Review provides practice recommendations applicable in the peri-operative period in IBD patients undergoing surgery.

DOP20 Functional viral neutralisation responses after SARS-CoV-2 infection in Inflammatory Bowel Disease patients receiving infusion therapies: Report from the ICARUS-IBD Consortium

BackgroundRecent data have highlighted adverse clinical outcomes in IBD patients treated with infliximab/thiopurines (IFX/THIO) upon infection with SARS-CoV-2, as well as attenuated serological responses after infection and vaccination in patients treated with IFX. To provide mechanistic insight, we explored the serological and functional anti-viral response after infection in IBD patients treated with VDZ, IFX or IFX/THIO compared to healthy controls to guide clinical decision-making regarding treatment and vaccination strategies.MethodsSerum from 640 IBD patients attending routine infusions in Oxford and London in May to December 2020 was screened for anti-SARS-CoV-2 antibody responses by the Abbott assay. Serum from seropositive patients was compared to seropositive health care workers (Table 1). Antibody reactivity to the SARS-CoV-2 wild type strain receptor-binding domain (RBD), full-length spike, and nucleocapsid was assayed by IgG/IgA ELISA over time as well as by IgG high-throughput MSD V-PLEX ELISA at the time of seropositivity. A pseudotyped SARS-CoV-2 virus microneutralization assay was used to detect neutralising antibodies to the wild type, and an ELISA-based inhibition assay to compare differential inhibition of the wild type vs. delta variant SARS-CoV-2 RBD-ACE2 interaction. ResultsAll IBD patients showed significantly reduced IgG antibody responses compared to healthy controls for all SARS-CoV-2 antigens, using MSD V-PLEX ELISA (Figure 1). The greatest reduction in IgG response by ELISA was observed in individuals treated with IFX/THIO (p=0.00019), whereas IgG response over time declined significantly faster in the IFX treated group (p=0.019). IgA responses were significantly reduced in the IFX/THIO group compared to healthy controls (p=0.009), but not in the IFX or VDZ monotherapy group. The rate of decline in these monotherapy groups was also not significantly different to healthy controls. Functional SARS-CoV-2 neutralisation was significantly lower in all IBD patients compared to healthy controls, with the greatest reduction in patients receiving IFX/THIO (Figure 2A; p=0.00000091). The delta variant inhibition capacity was significantly reduced in 68.1% of IBD patients (30/44, Figure 2B; p=0.0005). ConclusionIFX/THIO is associated with significantly lower IgA and IgG responses, and with impaired functional SARS-CoV-2 neutralising antibody capacity, compared to healthy individuals. Whilst IgG and neutralisation responses are reduced in each group of IBD patients, these findings were most pronounced in the combination treatment group. As neutralising antibody responses are associated with protection, this observation may impact on decision-making regarding treatment and vaccination/antiviral strategies.

S755 A Tale of Two IBD Centers: Disparities in Health Utilization and Outcomes in IBD Patients by Race, Employment, and Insurance Status at a Private and Public Hospital in New York City

S755 A Tale of Two IBD Centers: Disparities in Health Utilization and Outcomes in IBD Patients by Race, Employment, and Insurance Status at a Private and Public Hospital in New York City

S881 Impact of Inflammatory Bowel Disease on Maternal and Fetal Outcomes

Introduction: Inflammatory bowel disease is a disease of young age and incidence is highest during the reproductive years and current estimates are that only one quarter of female IBD patients will conceive. Due to increased incidence of IBD during reproductive years, many studies are performed to assess the impact of IBD on fertility and pregnancy outcomes, but the results from these studies are conflicting. The aim of our study was to assess the burden of adverse maternal and fetal outcomes in IBD patients. Methods: Using National inpatient sample (NIS) database from 2016 to 2018.All patients above age 15 with diagnosis of pregnancy including live or still birth after 20 weeks of gestation with a secondary diagnosis of Ulcerative colitis or Crohn Disease were included in the study. Maternal outcomes of interest were gestational diabetes (GDM), Gestational hypertension and its complications including Pre-eclampsia, Eclampsia and HELLP syndrome and Postpartum hemorrhage. Fetal outcomes studied were fetal growth restriction (FGR), large for gestational age infants (LGA), preterm birth and fetal death. Subgroup analysis was performed on UC and CD patients.The secondary outcomes were length of stay, maternal death, total hospital charges. Results: Multivariable logistic regression analysis was conducted after adjusting for patient and hospital level confounders. Pregnant ladies with IBD had more odds of GDM (AOR 1.55 95% CI 1.04-2.3, P-value 0.02), Gestational hypertension associated complications (AOR 1.35 95% CI 1.06-1.72, P-value 0.01) and postpartum hemorrhage (AOR 1.04 95% CI 0.84-1.29, P-value 0.68). Pregnancies with co-existent IBD lead to FGR (AOR 1.27 95%CI 1-1.63, P-value 0.05), as well more odds of pre-term delivery (< 37 weeks) and LGA infants (AOR, 1.41 95% CI 1.13-1.76 P-value 0.003, AOR 1.05 95% CI 0.79-1.40 P-value 0.69 respectively). IBD was also associated with higher odds of fetal death (AOR 3.21 95% CI 1.72-6.00 P-value < 0.01). Similar results were seen on subgroup analysis of UC and CD. Conclusion: Patients with IBD, CD and UC has worse maternal and fetal outcomes as well increased resource utilization. As IBD is disease of young population and majority of the patients are diagnosed in their 20s and 30s which coincides with the peak fertility period, and it is seen that woman with IBD voluntarily avoid pregnancy due to fear of worse outcomes. We suggest that women who have moderate to severe disease should get pre-conceptional counselling and treated aggressively to obtain remission.Table 1.: Maternal and Fetal outcomes in Inflammatory bowel disease , Ulcerative Colitis and Crohn Disease, Adjusted Analysis.

P224 Regular physical activity on IBD patients: impact on IBD natural history and related comorbidities

Abstract Background Regular physical activity (PA) has a potential antioxidant and anti-inflammatory effect that is mainly exerted on adipose tissue, skeletal muscle, and the immune and cardiovascular systems. Thus, PA is known to be beneficial in different pro-inflammatory conditions. Nevertheless, data on the role of PA in IBD patients is scarce. The aim of our study is to analyse the association of PA with clinical outcomes in IBD patients. Methods Cross-sectional prospective study including all consecutive IBD patients attended at a university hospital was performed. Data on physical activity was recorded through the International Physical Activity Questionnaire (IPAQ). Metabolic Equivalent Task (MET) hours per week were calculated according to the combination of walking, moderate-intensity or vigorous intensity activity, and patients were categorized into low, moderate or high PA according to a previously validated method. Data on IBD phenotype, activity indexes, natural history, current and past treatments, together with liver evaluation, and history of cardiovascular risk factors were also collected. Results 831 patients were included in the study. Study flow chart is depicted in figure and clinical characteristics in table 1. IBD patients with a low or moderate PA showed a tendency to a higher proportion of IBD-related complications and higher scores in disease activity indexes than those with high PA. PA was strongly associated to the metabolic profile. Patients with a low/moderate PA were more frequently obese, hypertense, diabetic and had dyslipidaemia. Regarding liver disease, PA was significantly associated to the presence of non-alcoholic fatty liver disease (NAFLD), but not with advanced liver fibrosis. Conclusion Insufficient PA can negatively impact clinical outcomes in IBD patients, probably not because of a direct effect on IBD-pathogenesis, but due to its strong association with cardiovascular risk factors and NAFLD.

DOP90 Physician global assessment of IBD Activity is associated with COVID-19 severity in patients aged less than 50 years

BackgroundSECURE-IBD is an international database that monitors COVID-19 outcomes in IBD patients. We examined the influence of IBD activity (reflected by Physician Global Assessment (PGA)) on COVID-19 severity, while exploring the modifying effect of age.MethodsWe analyzed 3,028 cases reported to SECURE-IBD from March 13-November 17, 2020. PGA was categorized as remission/mild (reference) vs moderate vs severe. Outcomes used as surrogates of severe SARS-CoV2 infection were hospitalization and a composite of ICU/ventilation/death. Using generalized estimating equations (GEE) to account for clustering by country, we determined the unadjusted association between disease activity and COVID-19 outcomes, overall and by age decade. We included the following covariates in multivariable GEE models a priori: time of COVID-19 diagnosis, age, sex, comorbidities (0, 1, ≥2), IBD type, systemic corticosteroids (CS), anti-TNF monotherapy, anti-TNF plus immune modulator, immune modulator monotherapy, and mesalamine. We included additional covariates (country GDP, race, BMI, anti-integrins and ustekinumab) if they changed the estimate by ≥10%. We also built models stratified by age; the age cut-off for stratification was determined using Joinpoint regression (selecting the age at which outcome rates significantly changed).ResultsCOVID-19 was more severe in patients with more active IBD: hospitalization rates 19% (remission/mild), 26% (moderate) and 45% (severe); ICU/ventilation/death rates 5% (remission/mild), 6% (moderate) and 12% (severe) (p<0.05, Figure 1). In unadjusted analyses, higher PGA was associated with an increased risk of hospitalization (moderate: OR 1.53, 95% CI 1.24–1.88; severe: OR 3.30, 95% CI 2.44–4.46) and ICU/ventilation/death (moderate: OR 1.44, 95% CI 1.10–1.87; severe: OR 2.58, 95% CI 1.71–3.90). As per Figure 2, the magnitude of association between severe PGA (vs remission/mild) and adverse outcomes was greatest in patients ≤50 years. Joinpoint regression also supported a significant change in the rate of ICU/ventilation/death at 50 years. In multivariable analyses (Figure 3), PGA remained significantly associated with hospitalization, but not ICU/ventilation/death. However, in multivariable analyses stratified by age, PGA was consistently associated with both hospitalization and ICU/ventilation/death in patients ≤50, but not >50 years. ConclusionOur data suggest an association between IBD activity, as assessed by PGA, and severe COVID-19 outcome with an increased risk in younger patients. Adequate IBD treatment despite the pandemic is needed to avert poor outcome to symptomatic SARS-CoV2 infections.

Characteristics and Outcomes of IBD Patients with COVID-19 on Tofacitinib Therapy in the SECURE-IBD Registry.

Characteristics and Outcomes of IBD Patients with COVID-19 on Tofacitinib Therapy in the SECURE-IBD Registry.

Effect of IBD medications on COVID-19 outcomes: results from an international registry

ObjectiveWe sought to evaluate COVID-19 clinical course in patients with IBD treated with different medication classes and combinations.DesignSurveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is...

S3217 Sarcopenia Defined by Psoas Muscle Thickness Is Not a Predictor of Post-Operative Outcomes in IBD Patients

S3217 Sarcopenia Defined by Psoas Muscle Thickness Is Not a Predictor of Post-Operative Outcomes in IBD Patients