T1315 Crohn's Disease Duration is Associated With Increased Health Care Resource Utilization and...
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in CD patients were most commonly associated with surgical complications and infections, but not malignancy. T1313 Interleukin 1 Antagonist (IL-1ra) and Interleukin Beta (IL-1β) Polymorphisms are Associated With Steroid Dependence in Patients With Ulcerative Colitis Jesus K. Yamamoto-Furusho, Jean J. Santiago-Hernandez, Gilberto Vargas-Alarcon Background: Ulcerative colitis (UC) is an inflammatory bowel disease of unknown etiology. Among cytokines induced in UC, interleukin 1 antagonist (IL-1ra) and interleukin 1 beta (IL-1β) appears to have a central role because of its immunological up-regulatory and pro- inflammatory activities. Aim: To determine the association between IL-1RA and IL-1B gene polymorphisms and the clinical features of UC in the Mexican Mestizo population. Patients and Methods: Five polymorphisms in the IL-1 gene cluster members IL-1B (rs16944), IL1F10 (rs3811058) and IL-1RN (rs419598, rs315952, and rs315951) were genotyped by 5' exonuclease TaqMan genotyping assays in a group of 200 Mexican patients with UC and 248 ethnically matched unrelated healthy controls. Results: We found a significant increased frequencies of IL-1RN6/1 TC (rs315952) and RN6/2 CC (rs315951) and decreased frequency of IL-1B-511 TC (rs16944) genotypes in UC patients as compared to healthy controls. In the subgroup analysis, we found a significant association between the RN6/2 GG (rs315951) and IL-1B-511 CC (rs16944) genotypes and the presence of steroid-dependence in UC patients (pC=00001, OR=15.6 and pC=0.008, OR=4.09, respectively). Patients with UC showed increased frequencies of IL-1RN “CTC” and “TCG” haplotypes when compared to healthy controls (p=0.019, OR=1.43 and p<10-7, OR=2.63, respectively). Two haplotypes (TTG and CTG) showed decreased frequency in patients when compared healthy controls (p=9x10-7, OR=0.11 and p=8x10-6, OR=0.11, respectively). Conclusion: the IL-1 RN and IL-1B polymorphisms were associated with the genetic susceptibility to develop UC and were also associated with the presence of steroid-dependence in UC patients. T1314 Rates of Sepsis and Mortality Among IBD Patients With Thiopurine-Induced Leukopenia Yuki Young, Aelaf Worku, Thomas A. Ullman INTRODUCTION: Thiopurines (TPs), frequently used in the treatment of IBD, have been associated with leukopenia (LP). The risks for sepsis and death among IBD patients (pts) with LP are poorly understood. Estimates in models examining the effectiveness of TPMT testing and TP metabolite monitoring have estimated sepsis for TP-induced LP at 18%, and mortality for pts with TP-induced LP with sepsis at 40%, but these supporting estimates come from relatively small samples. AIM: The specific aim of this study was to characterize TP-induced LP among hospitalized IBD pts to determine its incidence and factors associated with related sepsis and mortality. METHODS: Following IRB approval and in keeping with HIPAA regulations, a clinical database of a tertiary care hospital with recognized IBD expertise was queried to identify all IBD pts admitted over a 7 year period (2002-2009) and to quantify the number of such pts with LP (WBC<4.0). Review also assessed exposure to TPs, sepsis, and hospital-based mortality. Demographic and clinical information of these pts was also abstracted. Rates of sepsis and death were calculated for pts; the effect of TP exposure, LP with TP, and type of disease (Crohn's vs. ulcerative colitis) upon sepsis and death were calculated using Fisher's exact testing, with p<0.05 considered significant. RESULTS: We identified 9923 hospitalized IBD pts over the 7 year period. Of these, 2066 were exposed to TPs. Among the TP-treated patients, 1838 had LP. There were 433 patients with sepsis and 159 deaths in the admitted IBD pt population. Pts with TP exposure were less likely to develop sepsis (2.8% vs 5.0%, p<0.0001) but more likely to die (5.6% vs 0.6%, p<0.0001) than non-TP IBD pts. Pts on TPs with LP were more likely to develop sepsis and die than TP-exposed pts without LP (both at 5.9% vs 0%, p=0.0003 and p<0.0001). There was a non-significant increase in sepsis and mortality with UC as compared to Crohn's (4.6% vs 4.1%, and 1.9% vs 1.3%, p=NS both comparisons). CONCLUSION: Sepsis and mortality associated with TP-induced LP occur at rates far below that which has been previously estimated. While monitoring thiopurines metabolites may still be important in specific clinical scenarios, models supporting their routine use should be revised to reflect the lower incidence of TP-induced LP-associated sepsis and death than had been previously reported. T1315 Crohn's Disease Duration is Associated With Increased Health Care Resource Utilization and Comorbidity Development Andrew P. Yu, Jackson Tang, Mei Lu, Jingdong Chao, Parvez Mulani, Mei Yang INTRODUCTION: We investigated whether health care resource utilization and comorbidi- ties differ over time, comparing patients (pts) with existing Crohn's disease (CD), pts with newly diagnosed CD, and the general population. METHODS: We obtained data from a national US health insurance database, Medstat MarketScan (1999-2006). Index date was the first CD diagnosis date. The newly diagnosed cohort consisted of pts without a CD diagnosis for at least 1 year prior to index date. The remainder of pts in the sample were pts with existing CD. For the CD-free control cohort, index date was randomly selected. Control pts without CD were matched 1:1 to the newly diagnosed cohort based on age, sex, and demographic region. We followed all pts for a minimum of 1.5 years until disen- rollment or initiation of biologic therapy. Outcomes included health care resource utilization and diagnosis of comorbidities occurring from 6 months after index date to the end of follow-up. We compared comorbidity risks between cohorts using Kaplan-Meier survival analysis and the log-rank test. We used the Cox model for age-adjusted comparison. We applied models using generalized estimating equations with Poisson distribution and log- link function to analyze the rate of yearly health care resource utilization. RESULTS: Com- pared with the newly diagnosed cohort (N=11,097), the existing CD cohort (N=23,304) had significantly and increasingly greater rates of comorbidities (all p<0.05) and resource S-535 AGA Abstracts use (all p<0.01) over time (table). The existing CD cohort also had significantly greater age- adjusted risks of developing anemia, malnutrition, anal fissures, and fistulas or intestinal abscesses vs. the newly diagnosed cohort (hazard ratios: 1.58, 1.54, 1.26, and 2.31, respect- ively; all p<0.01). Compared with the control cohort, the newly diagnosed cohort had significantly greater risks of anemia, asthma, cardiovascular disease, and colorectal cancer (all differences >1.0%; all p<0.01) plus significantly greater predicted numbers of surgeries over the 4-year period (p=0.04). CONCLUSION: Burden of health care resource utilization and comorbidity risk over time increased for pts with CD of longer duration. ΔComorbidities and ΔHealth Care Resource Utilization a All p<0.05. b All p<0.01. T1316 Audit of Prevention of Opportunistic Infections in Immunosuppressed Patients With IBD: How Close are We to ECCO Guidelines? Tim Elliott, Julie Duncan, Pritash Patel, Melissa Smith, Jeremy D. Sanderson, Peter M. Irving Aim The European Crohn's and Colitis Organisation (ECCO) has recently published recom- mendations on screening and prevention of opportunistic infections (OIs) in inflammatory bowel disease (IBD) patients. These are based on expert opinion and available evidence, and are more extensive than previous guidelines. The aim of this audit is to compare current practice of screening for, and prevention of, OIs in our IBD clinic, with these recommendations, and to examine the implications of following the guidelines. Materials and Methods IBD patients at risk of OIs (as defined by ECCO; those treated with thiopurines, methotrexate, anti-TNF or prednisolone > 20mg daily for > 2 weeks) were selected consecut- ively from our IBD clinic and infliximab infusion service from July to November 2009. A data collection sheet was completed for each patient by direct questioning in clinic and by review of patients' records. Information collected included; demographic and clinical details, immunosuppressive medication (IM), screening tests performed (HBsAg, anti-HBs, antiHBc, HCVAb, HIVAb, VZVAb (not applicable (n/a) if history of VZV infection), CXR and cervical smear (females)), and vaccinations given prior to treatment (Hepatits B, VZV (n/a if history of VZV infection), HPV (women < 26 years), influenza and Strep. pneumoniae). A cost analysis of this screening and vaccination strategy was performed. Results Ninety patients (Crohn's disease (n=70), Ulcerative Colitis (n=19), IBD-unclassified (n=1)) were audited to the time of abstract submission. Of these, 46 were male and 44 female (median age 32 years). Forty-one percent of patients were taking thiopurine monotherapy, 34% concomitant thiopurine and anti-TNF therapy, 14% anti-TNF monotherapy, 6% prednisolone, and 5% methotrexate. The proportion of patients who had recommended screening tests and vaccina- tions are shown in Tables 1 and 2 respectively. Patients on anti-TNF therapy were more likely to have undergone CXR, hepatitis B and C screening (p<0.05). The cost of performing the screening tests and vaccinations (excluding HPV) was USD$419 per patient. Conclusions Our current practice of screening for and prevention of opportunistic infections in at risk IBD patients is not in line with recent ECCO recommendations. However, some of these are based on limited evidence. Therefore, ongoing research and proof of cost benefit may be required before they gain widespread acceptance. Table 1: Screening tests Table 2: Vaccinations T1317 Serologic Markers (ASCA IgA, Anti-CBIR1, and pANCA) are Associated With the Development of Postoperative Complications in Ulcerative Colitis Patients Undergoing Ileal Pouch-Anal Anastomosis Jennifer Coukos, Jeremy T. Hetzel, Arthur Stucchi, James M. Becker, Kleanthis Dendrinos, Linda Alexander, Siobhan Nevin, Francis A. Farraye <p>Purpose: Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients with ulcerative colitis (UC). Common postoperative complications include chronic pouchitis (5-15%), fistulae (3-10%), Crohn's disease (CD) of the pouch (3-15%) and pouch failure (4-10%). This study aims to determine if serologic markers are associated with postoperative complications of the pouch in presumed UC patients undergoing IPAA. Methods: A retrospective chart review was conducted at Boston Medical Center of UC patients who had undergone IPAA. Postoperative IPAA patients seen at the Center for AGA Abstracts
Transcript of T1315 Crohn's Disease Duration is Associated With Increased Health Care Resource Utilization and...
in CD patients were most commonly associated with surgical complications and infections,but not malignancy.
T1313
Interleukin 1 Antagonist (IL-1ra) and Interleukin Beta (IL-1β) Polymorphismsare Associated With Steroid Dependence in Patients With Ulcerative ColitisJesus K. Yamamoto-Furusho, Jean J. Santiago-Hernandez, Gilberto Vargas-Alarcon
Background: Ulcerative colitis (UC) is an inflammatory bowel disease of unknown etiology.Among cytokines induced in UC, interleukin 1 antagonist (IL-1ra) and interleukin 1 beta(IL-1β) appears to have a central role because of its immunological up-regulatory and pro-inflammatory activities. Aim: To determine the association between IL-1RA and IL-1B genepolymorphisms and the clinical features of UC in the Mexican Mestizo population. Patientsand Methods: Five polymorphisms in the IL-1 gene cluster members IL-1B (rs16944),IL1F10 (rs3811058) and IL-1RN (rs419598, rs315952, and rs315951) were genotyped by5' exonuclease TaqMan genotyping assays in a group of 200 Mexican patients with UC and248 ethnically matched unrelated healthy controls. Results: We found a significant increasedfrequencies of IL-1RN6/1 TC (rs315952) and RN6/2 CC (rs315951) and decreased frequencyof IL-1B-511 TC (rs16944) genotypes in UC patients as compared to healthy controls. Inthe subgroup analysis, we found a significant association between the RN6/2 GG (rs315951)and IL-1B-511 CC (rs16944) genotypes and the presence of steroid-dependence in UCpatients (pC=00001, OR=15.6 and pC=0.008, OR=4.09, respectively). Patients with UCshowed increased frequencies of IL-1RN “CTC” and “TCG” haplotypes when compared tohealthy controls (p=0.019, OR=1.43 and p<10-7, OR=2.63, respectively). Two haplotypes(TTG and CTG) showed decreased frequency in patients when compared healthy controls(p=9x10-7, OR=0.11 and p=8x10-6, OR=0.11, respectively). Conclusion: the IL-1 RN andIL-1B polymorphisms were associated with the genetic susceptibility to develop UC andwere also associated with the presence of steroid-dependence in UC patients.
T1314
Rates of Sepsis and Mortality Among IBD Patients With Thiopurine-InducedLeukopeniaYuki Young, Aelaf Worku, Thomas A. Ullman
INTRODUCTION: Thiopurines (TPs), frequently used in the treatment of IBD, have beenassociated with leukopenia (LP). The risks for sepsis and death among IBD patients (pts)with LP are poorly understood. Estimates in models examining the effectiveness of TPMTtesting and TP metabolite monitoring have estimated sepsis for TP-induced LP at 18%, andmortality for pts with TP-induced LP with sepsis at 40%, but these supporting estimatescome from relatively small samples. AIM: The specific aim of this study was to characterizeTP-induced LP among hospitalized IBD pts to determine its incidence and factors associatedwith related sepsis and mortality. METHODS: Following IRB approval and in keeping withHIPAA regulations, a clinical database of a tertiary care hospital with recognized IBD expertisewas queried to identify all IBD pts admitted over a 7 year period (2002-2009) and to quantifythe number of such pts with LP (WBC<4.0). Review also assessed exposure to TPs, sepsis,and hospital-based mortality. Demographic and clinical information of these pts was alsoabstracted. Rates of sepsis and death were calculated for pts; the effect of TP exposure, LPwith TP, and type of disease (Crohn's vs. ulcerative colitis) upon sepsis and death werecalculated using Fisher's exact testing, with p<0.05 considered significant. RESULTS: Weidentified 9923 hospitalized IBD pts over the 7 year period. Of these, 2066 were exposedto TPs. Among the TP-treated patients, 1838 had LP. There were 433 patients with sepsisand 159 deaths in the admitted IBD pt population. Pts with TP exposure were less likelyto develop sepsis (2.8% vs 5.0%, p<0.0001) but more likely to die (5.6% vs 0.6%, p<0.0001)than non-TP IBD pts. Pts on TPs with LP were more likely to develop sepsis and die thanTP-exposed pts without LP (both at 5.9% vs 0%, p=0.0003 and p<0.0001). There was anon-significant increase in sepsis and mortality with UC as compared to Crohn's (4.6% vs4.1%, and 1.9% vs 1.3%, p=NS both comparisons). CONCLUSION: Sepsis and mortalityassociated with TP-induced LP occur at rates far below that which has been previouslyestimated. While monitoring thiopurines metabolites may still be important in specificclinical scenarios, models supporting their routine use should be revised to reflect the lowerincidence of TP-induced LP-associated sepsis and death than had been previously reported.
T1315
Crohn's Disease Duration is Associated With Increased Health Care ResourceUtilization and Comorbidity DevelopmentAndrew P. Yu, Jackson Tang, Mei Lu, Jingdong Chao, Parvez Mulani, Mei Yang
INTRODUCTION: We investigated whether health care resource utilization and comorbidi-ties differ over time, comparing patients (pts) with existing Crohn's disease (CD), pts withnewly diagnosed CD, and the general population. METHODS: We obtained data from anational US health insurance database, Medstat MarketScan (1999-2006). Index date wasthe first CD diagnosis date. The newly diagnosed cohort consisted of pts without a CDdiagnosis for at least 1 year prior to index date. The remainder of pts in the sample werepts with existing CD. For the CD-free control cohort, index date was randomly selected.Control pts without CD were matched 1:1 to the newly diagnosed cohort based on age,sex, and demographic region. We followed all pts for a minimum of 1.5 years until disen-rollment or initiation of biologic therapy. Outcomes included health care resource utilizationand diagnosis of comorbidities occurring from 6 months after index date to the end offollow-up. We compared comorbidity risks between cohorts using Kaplan-Meier survivalanalysis and the log-rank test. We used the Cox model for age-adjusted comparison. Weapplied models using generalized estimating equations with Poisson distribution and log-link function to analyze the rate of yearly health care resource utilization. RESULTS: Com-pared with the newly diagnosed cohort (N=11,097), the existing CD cohort (N=23,304)had significantly and increasingly greater rates of comorbidities (all p<0.05) and resource
S-535 AGA Abstracts
use (all p<0.01) over time (table). The existing CD cohort also had significantly greater age-adjusted risks of developing anemia, malnutrition, anal fissures, and fistulas or intestinalabscesses vs. the newly diagnosed cohort (hazard ratios: 1.58, 1.54, 1.26, and 2.31, respect-ively; all p<0.01). Compared with the control cohort, the newly diagnosed cohort hadsignificantly greater risks of anemia, asthma, cardiovascular disease, and colorectal cancer(all differences >1.0%; all p<0.01) plus significantly greater predicted numbers of surgeriesover the 4-year period (p=0.04). CONCLUSION: Burden of health care resource utilizationand comorbidity risk over time increased for pts with CD of longer duration.ΔComorbidities and ΔHealth Care Resource Utilization
aAll p<0.05. bAll p<0.01.
T1316
Audit of Prevention of Opportunistic Infections in Immunosuppressed PatientsWith IBD: How Close are We to ECCO Guidelines?Tim Elliott, Julie Duncan, Pritash Patel, Melissa Smith, Jeremy D. Sanderson, Peter M.Irving
Aim The European Crohn's and Colitis Organisation (ECCO) has recently published recom-mendations on screening and prevention of opportunistic infections (OIs) in inflammatorybowel disease (IBD) patients. These are based on expert opinion and available evidence,and are more extensive than previous guidelines. The aim of this audit is to comparecurrent practice of screening for, and prevention of, OIs in our IBD clinic, with theserecommendations, and to examine the implications of following the guidelines. Materialsand Methods IBD patients at risk of OIs (as defined by ECCO; those treated with thiopurines,methotrexate, anti-TNF or prednisolone > 20mg daily for > 2 weeks) were selected consecut-ively from our IBD clinic and infliximab infusion service from July to November 2009. Adata collection sheet was completed for each patient by direct questioning in clinic and byreview of patients' records. Information collected included; demographic and clinical details,immunosuppressive medication (IM), screening tests performed (HBsAg, anti-HBs, antiHBc,HCVAb, HIVAb, VZVAb (not applicable (n/a) if history of VZV infection), CXR and cervicalsmear (females)), and vaccinations given prior to treatment (Hepatits B, VZV (n/a if historyof VZV infection), HPV (women < 26 years), influenza and Strep. pneumoniae). A costanalysis of this screening and vaccination strategy was performed. Results Ninety patients(Crohn's disease (n=70), Ulcerative Colitis (n=19), IBD-unclassified (n=1)) were audited tothe time of abstract submission. Of these, 46 were male and 44 female (median age 32years). Forty-one percent of patients were taking thiopurine monotherapy, 34% concomitantthiopurine and anti-TNF therapy, 14% anti-TNF monotherapy, 6% prednisolone, and 5%methotrexate. The proportion of patients who had recommended screening tests and vaccina-tions are shown in Tables 1 and 2 respectively. Patients on anti-TNF therapy were morelikely to have undergone CXR, hepatitis B and C screening (p<0.05). The cost of performingthe screening tests and vaccinations (excluding HPV) was USD$419 per patient. ConclusionsOur current practice of screening for and prevention of opportunistic infections in at riskIBD patients is not in line with recent ECCO recommendations. However, some of theseare based on limited evidence. Therefore, ongoing research and proof of cost benefit maybe required before they gain widespread acceptance.Table 1: Screening tests
Table 2: Vaccinations
T1317
Serologic Markers (ASCA IgA, Anti-CBIR1, and pANCA) are Associated Withthe Development of Postoperative Complications in Ulcerative Colitis PatientsUndergoing Ileal Pouch-Anal AnastomosisJennifer Coukos, Jeremy T. Hetzel, Arthur Stucchi, James M. Becker, Kleanthis Dendrinos,Linda Alexander, Siobhan Nevin, Francis A. Farraye
<p>Purpose: Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment forpatients with ulcerative colitis (UC). Common postoperative complications include chronicpouchitis (5-15%), fistulae (3-10%), Crohn's disease (CD) of the pouch (3-15%) and pouchfailure (4-10%). This study aims to determine if serologic markers are associated withpostoperative complications of the pouch in presumed UC patients undergoing IPAA.Methods: A retrospective chart review was conducted at Boston Medical Center of UCpatients who had undergone IPAA. Postoperative IPAA patients seen at the Center for
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