Biologics for IBD May Come With Added Risks in Hispanic Patients

Biologic agents may not be as safe or effective in Hispanic patients with inflammatory bowel disease (IBD) as they are in non-Hispanic patients, suggest new data published online in Clinical Gastroenterology and Hepatology.

To compare risk for hospitalization, surgery, and serious infections, Nghia H. Nguyen, MD, and his team at the Inflammatory Bowel Disease Center at the University of California, San Diego, in La Jolla included a multicenter, electronic health record–based cohort of biologic-treated Hispanic and non-Hispanic patients with IBD and used 1:4 propensity score matching.

They compared 240 Hispanic patients (53% male; 45% with ulcerative colitis; 73% treated with tumor necrosis factor alpha [TNF-alpha] antagonist; 20% with prior biologic exposure) with 960 non-Hispanic patients (51% male; 44% with ulcerative colitis; 67% treated with TNF-alpha antagonist; 27% with prior biologic exposure). Participants were new users of biologics (TNF-alpha antagonist, ustekinumab, or vedolizumab).

Compared with non-Hispanic patients, Hispanic patients had a higher risk for all-cause hospitalization (31% vs 23%) within 1 year of starting a biologic agent.

Hispanic patients also had almost twice the risk for IBD-related surgeries (7% vs 4.6%, respectively) and trended toward a higher risk for serious infection (8.8% vs 4.9%, respectively).

The findings are particularly important because incidence and prevalence of IBD in Hispanic adults are increasing rapidly, according to the authors.

“Currently, 1.2% of Hispanic adults in the United States report having IBD, and this number is expected to increase progressively over the next few years with global immigration patterns and changing demographics of the United States,” the authors write.

Potential Drivers of Disparities

Hispanic patients have been underrepresented in clinical trials of biologic agents in IBD, making up fewer than 5% of participants, the authors note. This has resulted in limited data and created challenges in discerning reasons for the disparity.

The authors note the potential role of genetics in the effectiveness of some biologic agents, although that has not been well studied in Hispanic patients.

Additionally, according to this study, Hispanic patients with IBD lived with more negative social determinants of health, particularly related to food insecurity (27%) and lack of adequate social support (83%), compared with non-Hispanic patients (unpublished data).

“In other studies on health care utilization, Hispanic patients were found to have limited access to appropriate specialist care and lack of insurance coverage,” the authors point out.

The authors acknowledge that limitations of their study include the inability to pinpoint the primary reason for hospitalization because data on primary vs secondary discharge diagnoses were not available. Also, they relied on prescription information in electronic health records and could not confirm that medications were dispensed or that patients took them.

They also acknowledged selection bias as a limitation because the focus was only on patients treated with biologics, and not on outcomes for those who may have warranted a biologic treatment but were unable to receive it.

“Future studies are needed to investigate the biological, social, and environmental drivers of these differences,” the authors write.

The authors’ complete financial disclosures are available with the full text of the paper.

Clinical Gastroenterology and Hepatology. Published online May 26, 2022. Abstract

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

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