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Background Smoking has been associated with a reduced response to anti-TNF in patients with inflammatory bowel disease (IBD) as well as with lower serum levels of anti-TNF agents and the development of antibodies against them. The aim of this study was to investigate the association between smoking and the appearance of adverse events (AEs) of biologics in patients with IBD. Methods Consecutive patients with IBD who receive biological therapy in a tertiary university hospital were included. The possible association of smoking with the presence of AEs was investigated, using a specially designed questionnaire including a wide range of AEs associated with biologics (infections, skin manifestations, musculoskeletal disorders, general symptoms, hypersensitivity reactions, thromboembololic events and psychological disorders). Results A total of 147 patients with IBD under biologics [median age (IQR) 46 (32.5–56) years, Crohn’s Disease (CD) 109 (74%), female 51 (35%), under combination with immunosuppressants 60 (41 %), under intensified biologic therapy 50 (34%), under anti-TNF 132 (89%), vedolizumab 11 (7.5%), ustekinumab 3 (2%)] with completed questionnaire forms available were included in the study. There were 52 (35%) active smokers and 35 patients (24%) ex-smokers. The prevalence of all AEs was 86% in smokers 85% in ex-smokers and 78% in non-smokers. Active smoking was significantly associated with the presence of arthralgias and skin rashes while taking biologics, both in the univariate (P = 0.02 and 0.008 respectively-Figure 1) and in the multivariate analysis (P = 0.02 and 0.007 respectively). These correlations were the same for the two diseases (CD &amp; UC) except for arthralgias where there was a significant correlation only with CD (P = 0.02). There were no other significant associations between smoking and infections (P=0.77) or other AEs (P&amp;gt; 0.05). Conclusion Smoking is a predisposing factor for the development of AEs of biologics in patients with IBD. It could be suggested that quit of smoking may lead to the optimal benefit from the use of biologic therapy in IBD.

P505 Smoking is associated with the development of adverse events of biological therapy in patients with Inflammatory Bowel Disease