S1648 Mineralocorticoid Receptor Antagonist Use Is Associated With Improved Clinical Outcomes in Crohn’s Disease

Introduction: Crohn’s disease (CD) is marked by intestinal inflammation and often complicated by intestinal fibrosis and stricturing disease. Mineralocorticoid receptor antagonists (MRA), such as spironolactone and eplerenone, have demonstrated anti-fibrotic properties in preclinical studies, but their role in clinical, real-world studies has yet to be evaluated. We investigated their clinical effects in the context of stricturing Crohn’s disease. Methods: Using TriNetX, a large healthcare database comprising over 120 million patients in the United States, we identified cohorts of patients with CD on one or more CD medications using International Classification of Diseases-10 codes, and excluded those with cirrhosis or portal hypertension. We categorized these patients into 2 subgroups based on their exposure to MRA. Cases were CD patients on MRA, and controls were CD patients without exposure to MRA. The 2 cohorts were propensity matched for demographics, comorbidities including tobacco use, diabetes, and types of heart failure, inflammatory markers, and CD medications. The outcomes of interest were defined as CD-related surgery, steroid use, and intestinal strictures 3 months to 5 years after the index event of MRA use. We stratified our analysis by the inclusion or exclusion of prior intestinal strictures. Chi-square and t-tests were used for significance testing. Results: There were 7,305 cases and 149,104 controls. After propensity matching, 6,843 who were evenly matched. When compared to patients with CD and no exposure to MRA, those with CD on MRA were less likely to have CD-related surgery (OR 0.59, 95% CI 0.49-0.71) and steroid use (OR 0.83, 95% CI 0.78-0.89). Excluding those with prior stricturing disease, patients with CD on MRA were less likely to have intestinal strictures (OR 0.70, 95% CI 0.60-0.81), and this benefit persisted when including those with prior stricturing disease (OR 0.85, 95% CI 0.77-0.95). Conclusion: In this retrospective cohort study, we found that MRA were associated with decreased CD-related surgery, steroid use, and stricturing disease in patients with CD. These findings support the existing preclinical literature regarding a potential protective role of MRA in fibrostenotic disease. Further research is needed to investigate the clinical use of MRA as anti-fibrotic therapy in this population.