S1760 Impact of Iron Deficiency Anemia on Clinical Outcomes in Crohn’s Disease Patients Treated With Ustekinumab: A Retrospective Cohort Study

Introduction: Iron deficiency anemia (IDA) is a common comorbidity in Crohn’s disease, often associated with worsened disease burden. Its impact on clinical outcomes among patients receiving ustekinumab remains underexplored. Understanding IDA's influence can guide personalized treatment strategies in Crohn’s disease care. Methods: A retrospective cohort study using data from TriNetX Collaborative Network. It included adult patients (≥18 years) with ustekinumab treated Crohn’s disease before 12/31/2023 divided into 2 cohorts based on the presence of IDA. Propensity score matching (1:1) was done, comparing clinical outcomes of Crohn’s associated complication rates, mortality, cardiovascular events, diarrhea, and abdominal pain. Odds ratios (ORs) with 95% confidence intervals (CIs) and P-values were reported; statistical significance set at P < 0.05. Results: After propensity score matching, 1,678 patients were included in each group. The overall cohort’s mean ± SD age was 42.5 ± 17.1 years for patients with IDA and 42.5 ± 17.1 years for those without. Matching showed balance across cohorts (SD <0.01). IDA group compared to controls had statistical higher clinical complication risk (61.9% vs 49.2%; OR: 1.67, 95% CI: 1.46–1.92; P < 0.0001). IDA patients had higher mortality rates, but without statistical significance (2.0% vs 1.3%; OR: 1.52, 95% CI: 0.88–2.63; P = 0.124). IDA group showed significant elevation in intestinal obstruction risk (22.5% vs 17.2%; OR: 1.39, 95% CI: 1.17–1.65; P = 0.0001), fistula formation (18.1% vs 13.6%; OR: 1.40, 95% CI: 1.16–1.69; P = 0.0004), and abscess development (4.8% vs 2.7%; OR: 1.77, 95% CI: 1.22–2.56; P = 0.002). IDA group had statistically higher cardiovascular complications, including MI and HF (5.4% vs 2.7%; OR: 2.06, 95% CI: 1.43–2.96; P < 0.0001). In IDA group, diarrhea (19.2% vs 11.9%; OR: 1.77, 95% CI: 1.46–2.15; P < 0.0001) and abdominal pain (27.5% vs 20.7%; OR: 1.452, 95% CI: 1.24–1.70; P < 0.0001) were significantly more frequent. Conclusion: Among Crohn’s disease patients treated with ustekinumab, presence of iron deficiency anemia (IDA) was associated with significantly higher rates of clinical complications, intestinal obstruction, fistula and abscess formation, cardiovascular events, diarrhea, and abdominal pain. These findings suggest that IDA may adversely impact disease outcomes in this population, highlighting the importance of early identification and management of anemia in Crohn’s disease patients receiving ustekinumab therapy.