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Sunday Poster Session

Category: IBD

P0748 - Impact of Lipophilic Statin Use on Inflammatory Bowel Disease: A US Cohort Propensity-Matched Study

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall
ACG Outstanding Poster Presenter
Osama Hamid, MD, MRCPI1, Khaled Alsabbagh Alchirazi, MD1, Ahmed Eltelbany, MD, MPH1, Khalid Ahmed, MD2, Rama Nanah, MD1, Miguel Regueiro, MD3
1Cleveland Clinic, Cleveland, OH; 2The Wright Center for GME, Scranton, PA; 3Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH

Introduction: Statins have potential pleiotropic effects on inflammation, cellular proliferation and apoptosis. Lipophilic statins are widely distributed in tissues whereas hydrophilic statins are hepto-selective. We aim to investigate the impact of lipophilic statins on inflammatory bowel disease (IBD).

Methods: Using TriNetX, which aggregates data from >90 million patients' charts, we included adults and divided them into 3 groups: Crohn’s disease (CD) patients who were prescribed lipophilic statins (Atorvastatin, Simvastatin, Lovastatin or Fluvastatin), ulcerative colitis (UC) patients on lipophilic statins (2 case groups) and IBD patients not on statin (control). We conducted 1:1 propensity score matching within each group accounting for demographic variables, co-morbidities including DM, HTN, IHD, heart failure, cerebrovascular disease, obesity, CKD, smoking and alcohol abuse as well as the use of aspirin and IBD medications. We assessed IBD extra-intestinal manifestations, IBD outcomes and conducted Kaplan-Meier survival analysis to assess all-cause mortality.

Results: Among the 299,732 patients with CD in the database, 40,020 (13.3%) were on lipophilic statins and 279,803 patients with UC, of which 58,205 (20.8%) were on lipophilic statins. Demographic and co-morbidity data is presented in Table 1. After matching, CD group had a lower risk of PSC (aOR 0.75 [0.62-0.91]), cholangiocarcinoma (aOR 0.68 [0.49-0.94]), small bowel resection (aOR 0.82 [0.74-0.92]), intestinal fistula (aOR 0.84 [0.75-0.94]), perianal fistula (aOR 0.84 [0.78-0.96]), perianal abscess (aOR 0.88 [0.77-0.99]) and colorectal cancer (aOR 0.85 [0.75-0.96]), but had a higher prevalence of vitamin D deficiency (aOR 1.14 [1.09-1.19]). The UC group had a lower risk of arthropathy (aOR 0.76 [0.65-0.89]), pyoderma gangrenosum (aOR 0.79 [0.62-0.99]), PSC (aOR 0.73 [0.64-0.83]), cholangiocarcinoma (aOR 0.76 [0.60-0.96]), toxic megacolon (aOR 0.73 [0.59-0.91]), C-diff (aOR 0.77 [0.72-0.81]), colectomy (aOR 0.68 [0.59-0.78]) and colorectal cancer (aOR 0.83 [0.74-0.92]), but had a higher risk of osteoporosis (aOR 1.26 [1.21-1.32]), Figure 1. Furthermore, all-cause mortality was improved for both CD group (HR 0.77 [0.74-0.81]) and UC group (HR 0.89 [0.86-0.93]).

Discussion: Lipophilic statin use in patients with IBD was associated with a reduced risk of extraintestinal manifestations, disease related complications and improved all-cause mortality. Statin use in IBD is common and does not appear to have adverse effects on IBD.

Figure: Figure 1: Adjusted odds ratio of CD and UC extra-intestinal manifestations and outcomes in lipophilic statin users
Table1: characteristics of patients in cohorts
 CD with statin
(n= 40,020)		UC with statin
(n= 58,205)
Gender
Male
Female
18,437 (46.5%)
1,194 (53.5%)

28,853 (50.1%)
28,786 (49.9%)
Race
White
Black or African American
Hispanic
31,191 (78.7%)
3,947 (10.0%)
1,275 (3.2%)

44,950 (78.0%)
5,368 (9.3%)
2,257 (3.9%)
Conditions  
Diabetes mellitus10,971 (27.7%)18,449 (32.0%)
Hypertension22,591 (57.0%)36,516 (63.3%)
IHD9,932 (24.8%)16,437 (28.5%)
Heart failure4,543 (11.5%)8,089 (14.0%)
PVD2,839 (7.2%)4,870 (8.4%)
Cerebrovascular disease5,261 (13.3%)9,242 (16.0%)
CKD5,083 (12.8%)9,011 (15.6%)
Obesity15,317 (38.2%)26,262 (45.1%)
Alcohol abuse2,113 (5.2%)3,299 (5.6%)
Smoking14,674 (36.6%)20,543 (35.2%)
Medications  
Immunomodulators4,846 (12.1%)6,043 (10.3%)
Biologics5,928 (14.8%)7,445 (12.7%)
CD: Crohn’s disease; UC: ulcerative colitis; IHD: ischemic heart disease; PVD: peripheral vascular disease; CKD: chronic kidney disease

Table: Table1: characteristics of patients in cohorts


Disclosures:
Osama Hamid indicated no relevant financial relationships.
Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.
Ahmed Eltelbany indicated no relevant financial relationships.
Khalid Ahmed indicated no relevant financial relationships.
Rama Nanah indicated no relevant financial relationships.
Miguel Regueiro: AbbVie – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Alfasigma – Advisory Committee/Board Member, Consultant. Allergan – Advisory Committee/Board Member, Consultant. Amgen – Advisory Committee/Board Member, Consultant. Bristol Myers Squibb – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Celgene – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Eli Lilly – Advisory Committee/Board Member, Consultant. Genentech – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Gilead Sciences – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Janssen – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Miraca Labs – Advisory Committee/Board Member, Consultant. Pfizer Inc – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Prometheus – Advisory Committee/Board Member, Consultant. Salix – Advisory Committee/Board Member, Consultant. Seres – Advisory Committee/Board Member, Consultant. Takeda – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Target RWE – Advisory Committee/Board Member, Consultant. UCB – Advisory Committee/Board Member, Consultant, Unrestricted educational grants. Wolters Kluwer Health – Royalties.


Osama Hamid, MD, MRCPI1, Khaled Alsabbagh Alchirazi, MD1, Ahmed Eltelbany, MD, MPH1, Khalid Ahmed, MD2, Rama Nanah, MD1, Miguel Regueiro, MD3. P0748 - Impact of Lipophilic Statin Use on Inflammatory Bowel Disease: A US Cohort Propensity-Matched Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.