Effectiveness and Safety of Biologic Therapy in Hispanic Vs Non-Hispanic Patients With Inflammatory Bowel Diseases: A CA-IBD Cohort Study.
Effectiveness and Safety of Biologic Therapy in Hispanic Vs Non-Hispanic Patients With Inflammatory Bowel Diseases: A CA-IBD Cohort Study.
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西班牙裔与非西班牙裔炎症性肠病患者生物治疗的有效性和安全性：CA-IBD 队列研究。
DOI：
10.1016/j.cgh.2022.05.008
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发表时间：
2023
期刊：
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作者：
Nguyen,NghiaH;Luo,Jiyu;Paul,Paulina;Kim,Jihoon;Syal,Gaurav;Ha,Christina;Rudrapatna,Vivek;Park,Sunhee;Parekh,Nimisha;Zheng,Kai;Sauk,JennyS;Limketkai,Berkeley;Fleshner,Phillip;Eisenstein,Samuel;Ramamoorthy,Sonia;Melmed,Gil;
背景与目的关于西班牙裔炎症性肠道疾病（IBD）患者生物治疗结果的数据有限。我们比较了住院，手术和严重感染的风险，在西班牙裔与非西班牙裔IBD患者在一个多中心，电子健康记录为基础的队列biologic-treated patients.MethodsWe确定了成人IBD患者谁是新用户的生物制剂（肿瘤坏死因子α [TNF-α]拮抗剂，优特克单抗，Vedolizumab）从5个学术机构在加州之间2010年和2017年。我们使用1：4倾向评分匹配和生存分析比较了西班牙裔与非西班牙裔患者的全因住院、IBD相关手术和严重感染的风险。（53%男性; 45%溃疡性结肠炎; 73%接受TNF-α拮抗剂治疗; 20%既往有生物暴露），960例非西班牙裔患者（51%男性; 44%溃疡性结肠炎; 67%接受TNF-α拮抗剂治疗; 27%既往暴露于生物制剂）。倾向评分匹配后，西班牙裔患者更年轻（37 ± 15 vs 40 ± 16岁;P= 0.02），合并症负担更高（Elixhauser指数，>0; 37% vs 26%;P<0.01），在药物使用模式、炎症负担和住院方面没有任何差异。在开始生物制剂治疗的1年内，西班牙裔患者的住院率较高（31% vs 23%;校正风险比[aHR]，1.32; 95% CI，1.01-1.74）和IBD相关手术（7.1% vs 4.6%; aHR，2.00; 95% CI，1.07-3.72），严重感染风险有升高趋势（8.8%vs 4.9%，aHR，1.74; 95%CI，0.99-3.05）.结论：在一个多中心、倾向评分匹配的IBD生物制剂治疗患者队列中，西班牙裔患者的住院率、手术率和严重感染率较高。未来的研究需要调查这些差异的生物，社会和环境驱动因素。
Background & AimsThere are limited data on outcomes of biologic therapy in Hispanic patients with inflammatory bowel diseases (IBDs). We compared risk of hospitalization, surgery, and serious infections in Hispanic vs non-Hispanic patients with IBD in a multicenter, electronic health record–based cohort of biologic-treated patients.MethodsWe identified adult patients with IBD who were new users of biologic agents (tumor necrosis factor α [TNF-α] antagonists, ustekinumab, vedolizumab) from 5 academic institutions in California between 2010 and 2017. We compared the risk of all-cause hospitalization, IBD-related surgery, and serious infections in Hispanic vs non-Hispanic patients using 1:4 propensity score matching and survival analysis.ResultsWe compared 240 Hispanic patients (53% male; 45% with ulcerative colitis; 73% TNF-α antagonist–treated; 20% with prior biologic exposure) with 960 non-Hispanic patients (51% male; 44% with ulcerative colitis; 67% TNF-α antagonist–treated; 27% with prior biologic exposure). After propensity score matching, Hispanic patients were younger (37 ± 15 vs 40 ± 16 y;P= .02) and had a higher burden of comorbidities (Elixhauser index, >0; 37% vs 26%;P< .01), without any differences in patterns of medication use, burden of inflammation, and hospitalizations. Within 1 year of biologic initiation, Hispanic patients had higher rates of hospitalizations (31% vs 23%; adjusted hazard ratio [aHR], 1.32; 95% CI, 1.01–1.74) and IBD-related surgery (7.1% vs 4.6%; aHR, 2.00; 95% CI, 1.07–3.72), with a trend toward higher risk of serious infections (8.8% vs 4.9%; aHR, 1.74; 95% CI, 0.99–3.05).ConclusionsIn a multicenter, propensity score–matched cohort of biologic-treated patients with IBD, Hispanic patients experienced higher rates of hospitalization, surgery, and serious infections. Future studies are needed to investigate the biological, social, and environmental drivers of these differences.