OP07 Consistent IBD treatment approaches across South Asian and White ethnicities despite phenotypic variations: a study of 33,157 patients using the IBD BioResource
OP07 Consistent IBD treatment approaches across South Asian and White ethnicities despite phenotypic variations: a study of 33,157 patients using the IBD BioResource
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OP07 尽管存在表型差异，但南亚和白人的 IBD 治疗方法一致：使用 IBD BioResource 对 33,157 名患者进行的研究
DOI：
10.1093/ecco-jcc/jjad212.0007
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Balarajah S
中科院分区：
文献类型：
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作者：
Balarajah S
背景目前的证据表明，IBD表型存在种族差异，并且已经报道了治疗提供的差异。这个多中心队列研究利用英国IBD BioResource数据集，以评估南亚（SA）和白色（WH）IBD之间的表型差异，并探讨这些是否与治疗差异相关。使用卡方2（分类数据）和Mann-Whitney U（连续数据）检验。倾向评分匹配（PSM）占诊断时的年龄，性别，吸烟状况，疾病的位置和行为和肛周疾病（CD）。在倾向匹配（PM）队列中评估药物使用（多变量logistic回归）和手术结局（Kaplan-Meier和考克斯回归分析）的差异。结果纳入33，157例（31，932例WH; 1225例SA）患者（48.1%CD，45.4%UC，6. 5% IBD-U）。UC是SA的主要疾病亚型（UC，SA 57.3% vs WH 44.9%，p<0.001）。SA在诊断时更年轻[CD，SA 24（IQR 17-36）vs WH 26（IQR 19-39）岁，p<0.001; UC，SA 29（IQR 22-38）vs WH 35（25-48）岁，p<0.001]。与WH相比，SA CD的回肠疾病较少（SA 30.3% vs WH 38.4%，padj=0.008），肛周受累较多（SA 38.5% vs WH 32.3%，p=0.009）。SA CD狭窄率较低（SA 16.9%vsWH 25.6%，padj<0.001）。SA UC更可能有广泛的疾病（SA 41.7%vsWH 34.1%，padj<0.001）。非PSM队列的初步分析显示，接受手术的SA CD较少[SA（n= 157，37.4%）vs WH（n= 7532，50.4%），p<0.001]，SA组与对照组比较，差异无显著性（P> 0.05）。（n= 33，5.1%）和WH（n= 747，5.5%; p=0.15）UC接受结肠切除术。PSM用于匹配CD中的355 SA和355 WH，以及UC中的525 SA和525 WH。变量平衡良好。5-阿萨、皮质类固醇、巯嘌呤、抗TNF或Vedolizumab的使用无差异（表1）。在CD中，126例（36.5%）SA和152例（44.7%）接受了手术。CD中的生存分析显示手术时间无差异（图1A，对数秩0.28）。SA种族与CD患者手术风险增加无关（HR 0.82，95% CI 0.63-1.07，p=0.14）。在UC中，25例（4.8%）和37例（7.1%）WH行结肠切除术。结肠切除术的时间没有显著差异（图1B，对数秩0.12），SA种族也与结肠切除术风险增加无关（HR 0.65，95%CI 0.39-1.11，p=0.12）。考虑到这些差异，我们发现SA和WH提供的医疗和手术治疗相当。这些发现表明，在英国，来自不同种族背景的IBD患者得到了一致的护理。
BackgroundThe current evidence suggests ethnic distinctions in IBD phenotype, and differences in the provision of treatment have been reported. This multi-centre cohort study utilised the UK IBD BioResource dataset to evaluate phenotypic differences between South Asian (SA) and White (WH) IBD, and to explore if these were associated with differences in treatment.MethodsPhenotypic and outcome data were extracted from the IBD BioResource. Chi2(categorical data) and Mann-Whitney U (continuous data) tests were used. Propensity score matching (PSM) accounted for age at diagnosis, sex, smoking status, disease location and behaviour and perianal disease (CD). Differences in medication use (multivariable logistic regression) and surgical outcomes (Kaplan-Meier and Cox regression analysis) were assessed in propensity-matched (PM) cohorts.Results33,157 (31,932 WH; 1225 SA) individuals were included (48.1% CD, 45.4% UC, 6.5% IBD-U). UC was the predominant disease subtype in SA (UC, SA 57.3% vs WH 44.9%, p<0.001). SA were younger at diagnosis [CD, SA 24 (IQR 17-36) vs WH 26 (IQR 19-39) years, p<0.001; UC, SA 29 (IQR 22-38) vs WH 35 (25-48) years, p<0.001]. SA CD had less ileal disease (SA 30.3% vs WH 38.4%, padj=0.008), and more perianal involvement (SA 38.5% vs WH 32.3%, p=0.009) than WH. SA CD had less stricturing disease (SA 16.9% vs WH 25.6%, padj<0.001). SA UC were more likely to have extensive disease (SA 41.7% vs WH 34.1%, padj<0.001). Initial analyses in non-PSM cohorts showed that fewer SA CD underwent surgery [SA (n=157,37.4%) vs WH (n=7532,50.4%), p<0.001], and that similar proportions of SA (n=33,5.1%) and WH (n=747,5.5%; p=0.15) UC underwent a colectomy.PSM was used to match 355 SA to 355 WH in CD, and 525 SA to 525 WH in UC. Variables were well-balanced. There were no differences in 5-ASA, corticosteroid, thiopurine, anti-TNF or Vedolizumab use (Table 1). In CD, 126 (36.5%) SA and 152 (44.7%) had surgery. Survival analysis in CD showed no difference in the time to surgery (Fig 1A, log-rank 0.28). SA ethnicity was not associated with increased risk of surgery in CD (HR 0.82, 95% CI 0.63-1.07, p=0.14). In UC, 25 (4.8%) and 37 (7.1%) WH had a colectomy. There was no significant difference in the time to colectomy (Fig 1B, log-rank 0.12) nor was SA ethnicity associated with an increased risk of having a colectomy (HR 0.65, 95% CI 0.39-1.11, p=0.12).ConclusionIn the largest analysis of SA IBD to date, we have demonstrated phenotypic differences associated with ethnicity. Accounting for these variations, we have shown comparable provision of medical and surgical treatment in SA and WH. These findings indicate consistent care of IBD patients from different ethnic backgrounds in the UK.