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An Assessment of Comparative Medication Durability in Inflammatory Bowel Disease Patients With and Without Co-morbid Psoriasis, Rheumatoid Arthritis, and/or Enteropathic Arthritis

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Abstract

Background

Patients with inflammatory bowel disease (IBD) are at increased risk for many co-morbid diseases. However, little is known about durability of IBD medications in patients with co-morbid diseases.

Aims

Determine medication durability in IBD patients with and without psoriasis, rheumatoid arthritis, and/or enteropathic arthropathy.

Methods

All patients with at least three ICD-9 or 10 diagnoses for IBD were included in the cohort. The risk factors of interest were a co-morbid diagnosis of psoriasis (IBD-Ps), rheumatoid arthritis (IBD-RA), and/or enteropathic arthritis (IBD-EA). Medication durability was defined as days of medication use, calculated using order start and stop dates from the electronic medical record. Significant differences were tested using the Wilcoxon rank sum test for continuous variables and Fisher’s exact test or Pearson’s Chi-squared test, as appropriate, for categorical variables. Boxplots were constructed for graphical interpretation of results.

Results

In the psoriasis group, there were 481 patients with 831 medication exposures [131 IBS-Ps (16%), 700 IBD only (84%)]. The median days of medication use were numerically higher in the IBD-Ps group for all therapies [anti-TNF: 1109 vs 861 (p = 0.17); anti-IL-12/23: 984 vs 834 (p = 0.33); JAKi: 682 vs 230 (p = 0.13)], anti-TNF/IM: 370 vs 202 (p = 0.57), except anti-integrin therapy [214 vs 470 (p = 0.08)]. When restricting to UC only, patients with co-morbid again Ps had a significantly shorter duration on anti-integrin therapy (84 vs 456 days, p = 0.02). While not reaching statistical significance, there was a distinctly longer medication duration on JAKi therapy (910 vs 317, p = 0.10). When restricting to patients with CD only, no results reached statistical significance though there was a trend towards longer anti-TNF durability in CD-Ps (1340 vs 1000 days, p = 0.098). There were no differences in medication durability in IBD-RA or IBD-EA patients.

Discussion

Larger studies investigating medication durability of JAKi and anti-integrin therapy in IBD patients with psoriasis would be beneficial given noteworthy trends towards increased and decreased durability, respectively.

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Acknowledgments

The authors acknowledge the Michigan Genomics Initiative participants, Precision Health at the University of Michigan, and the University of Michigan Medical School Data Office for Clinical and Translational Research for providing data storage, management, processing, and distribution services.

Funding

KCC reports departmental funds. JEG is supported by Taubman Medical Research Institute and P30-AR075043. ES is supported in part by R01 DK106621, R01 DK107904, R01DK128871, R01DK131787 and The University of Michigan Department of Internal Medicine. PDRH is supported by R01 DK125687, R01 DK118154, T32 DK062708.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA

    Kelly Cushing, Elizabeth Speliotes & Peter D. R. Higgins

  2. Department of Dermatology, University of Michigan, Ann Arbor, MI, USA

    Johann E. Gudjonsson

  3. Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA

    Elizabeth Speliotes

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  1. Kelly Cushing
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Contributions

KC: study design, data analysis, results interpretation, drafting of the manuscript, critical review of the manuscript. JEG: results interpretation, critical review of the manuscript. ES: results interpretation, critical review of the manuscript. PDRH: study design, results interpretation, critical review of the manuscript.

Corresponding author

Correspondence to Kelly Cushing.

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Conflict of interest

KC: No conflicts of interest. JEG: Reports advisory board roles for Eli Lilly, Almirall, Novartis, BMS, Astra-Zeneca, Boehringer Ingelheim, Sanofi, Galderma, AnaptysBio, and research grants from Almirall, Eli Lilly, Kyowa Kirin, and BMS/Celgene. ES: No conflicts of interest. PDRH: Reports personal fees from Abbvie, personal fees from Eli Lilly, and personal fees from Pfizer, outside of the submitted work.

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Cushing, K., Gudjonsson, J.E., Speliotes, E. et al. An Assessment of Comparative Medication Durability in Inflammatory Bowel Disease Patients With and Without Co-morbid Psoriasis, Rheumatoid Arthritis, and/or Enteropathic Arthritis. Dig Dis Sci 68, 4001–4008 (2023). https://doi.org/10.1007/s10620-023-08062-5

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