S0656 Risk Factors for Thromboembolic Events Among Patients With Immune-Mediated Diseases

INTRODUCTION: Immune-mediated diseases (IMD) are linked to an increased risk of thromboembolic events (TE); however, systematic assessment of risk factors that may further impact TE risk is needed. This study evaluated the risk factor profile for TEs (deep vein thrombosis [DVT], pulmonary embolism [PE], myocardial infarction [MI], and ischemic stroke [IS]) among patients with IMDs. METHODS: Patients with ≥2 diagnoses for IMD from the IBM MarketScan Commercial and Medicare-Supplemental Claims database (2014–2018) were included. The index date was the day after a randomly selected IMD medical claim. Patients were followed for up to 4 years from the index date until the earliest of continuous follow-up [study period]. Baseline characteristics were assessed during the 1-year period prior to the index date [baseline period]. Multivariable regression was conducted to assess the risk factor profile for each TE. RESULTS: The cohort (N = 182,431) had an average age of 51.3 years and was predominantly female (64.3%). Risk factor profiles varied by TE. The largest consistent risk factor was the respective TE during baseline (e.g., compared to patients without baseline DVT, patients with baseline DVT had 41.1 times the rate of DVT during the study period, P < 0.001). Comorbidities, such as cardiovascular diseases (CVDs), type 2 diabetes, and peripheral vascular disease were associated with increased rates of MI (IRRs: 2.60, 1.30, 1.54, respectively; P < 0.05 for all) and IS (1.53, 1.54, 1.24, respectively; all P < 0.05); CVDs were also associated with increased rates of DVT (1.26, P < 0.01) and PE (1.28; P < 0.05). Use of glucocorticoids was associated with increased rates of DVT (1.20, P < 0.01), PE (1.19, P < 0.05), and MI (1.21, P < 0.05), but not IS (0.99; NS). Use of JAK inhibitors were associated with an increased rate of PE (2.52; P < 0.05) and numerically increased rates of DVT (1.23; NS) and IS (1.82; NS). Use of S1P-receptor modulators was associated with decreased rates for all types of TE, with significant findings for IS (DVT: 0.61; NS; PE: 0.30, NS; MI: 0.54, NS; IS: 0.33, P < 0.05). CONCLUSION: Several factors were found to have an additional impact on the rate of TE. These risk factors included previous TE, comorbidities, and classes of medications. Some treatments were found to increase the risk (e.g., glucocorticoids, JAK inhibitors), whereas others were found to mitigate the risk (e.g., S1P-receptor modulators). Further studies are warranted to validate these modifiable factors among patients with IMD.