P1624 - Natural Outcomes of New-Onset Inflammatory Bowel Disease Among Patients With Multiple Sclerosis

Shiv Gandhi, MD, Sara Zelman, MD, Sushrut Jangi, MD
Tufts University Medical Center, Boston, MA

Introduction: An association between inflammatory bowel disease (IBD) and multiple sclerosis (MS) has been previously suggested, as patients with IBD have an increased risk of being diagnosed with MS. However, the impact of preexisting MS on the natural course of IBD remains poorly understood, and a therapeutic strategy for managing patients with both diagnoses remains unclear.

Methods: We retrospectively studied 28 MS patients who later developed IBD (MS-IBD) managed at 3 US tertiary medical centers between 2000 and 2016from time of initial presentation to last documented visit. MS-IBD patients were matched to 112 patients with IBD alone in 1:4 ratio by diagnosis subtype (ulcerative colitis or Crohn's disease) and gender. Demographic and phenotypic characteristics including disease extent, disease distribution, medication use patterns, and procedural utilization were evaluated and compared between the two groups. Odds ratios and correlations were performed using R studio.

Results: Among 28 patients with MS-IBD, we found similar disease phenotype compared to patients with IBD alone, with similar rates of stricturing (21.4% vs 30.9%, p=0.743) and fistulizing disease (14.3% vs 5.5%, p=0.266). However, MS-IBD patients were less likely to be on anti-TNF therapy (7.1% vs 49.1%, p < 0.005). Of the 2 MS-IBD patients for whom anti-TNFs were used, this therapy did not worsen their MS. MS-IBD patients were numerically less likely to use thiopurines (32.1% vs 52.7%, p=0.059) and more likely to be started on natalizumab (25.0% vs 1.8%, p < 0.005) although had similar rates of vedolizumab use (0% vs 6.3%, p=0.345). Anti-CD20 and S1p immunomodulatory therapies were used in MS-IBD but not in IBD alone. Despite differences in the biologic therapies utilized, MS-IBD and IBD patients had similar rates of IBD-related surgery (21.4% vs 27.7%, p=0.634).

Discussion: Patients with MS-IBD are less likely to utilize anti-TNF therapies and are more likely to use anti-integrin therapies. Despite these therapeutic strategies, MS-IBD patients had similar rates of IBD related surgery, suggesting that avoidance of anti-TNF therapy does not worsen clinical outcomes in this patient population (Figure 1).




Disclosures:


Shiv Gandhi, MD, Sara Zelman, MD, Sushrut Jangi, MD. P1624 - Natural Outcomes of New-Onset Inflammatory Bowel Disease Among Patients With Multiple Sclerosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.