Long-term outcomes of patients with Crohn's disease who received infliximab or adalimumab as the first-line biologics
Long-term outcomes of patients with Crohn's disease who received infliximab or adalimumab as the first-line biologics
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DOI：
10.1111/jgh.14624
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发表时间：
2019-08-01
影响因子：
4.1
通讯作者：
Okada, Hiroyuki
中科院分区：
文献类型：
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作者：
Inokuchi, Toshihiro;Takahashi, Sakuma;Okada, Hiroyuki
背景与目的尽管以前的研究比较了英夫利昔单抗(ifliximab，IFX)和阿达利单抗(adalimumab，ADA)作为治疗克罗恩病(Crohn‘s disease，CD)的一线生物制剂的疗效，但首次使用哪种生物制剂对长期预后的影响尚未见报道。特别是，一线生物制剂的反应丧失(LOR)后的临床过程在很大程度上是未知的。方法采用多中心回顾性研究方法。对开始接受IFX或ADA治疗的生物初治CD患者的病程进行评估，即使在最初的生物制品LOR之后也是如此。结果共有263例CD患者进入分析，其中183例先用IFX治疗，80例先用ADA治疗。中位观察期为64.2个月。先接受IFX治疗和先接受ADA治疗的患者的累积非激素缓解率和无手术缓解率没有显著差异(对数等级检验，分别为P=0.42和P=0.74)。此外，在患者组之间与无效相关的事件的发生率(修改的抗肿瘤坏死因子治疗，包括强化、转换、停止或手术)没有显著差异(对数等级检验P=0.62)。首先接受IFX治疗的患者可能会因为不良事件而停止使用该药，而首先接受ADA治疗的患者可能会因为治疗失败或LOR而停止使用该药物。结论先用IFX和先ADA治疗的生物初治CD患者的远期预后无显著差异。
Background and Aim Although previous studies compared the efficacy of infliximab (IFX) versus adalimumab (ADA) as the first-line biologics for Crohn's disease (CD), the difference in long-term prognosis based on which biologic was used first has scarcely been reported. In particular, the clinical courses after loss of response (LOR) of the first-line biologics are largely unknown. Methods A multicenter, retrospective study was performed. Disease courses of biologic-naive CD patients who were started on IFX or ADA treatment were evaluated, even after LOR of the initial biologics. Results In total, 263 CD patients were eligible for analysis, 183 were treated with IFX first, and 80 were treated with ADA first. The median observation period was 64.2 months. The cumulative steroid-free remission rates and surgery-free rates did not differ significantly between the patients treated with IFX first and those treated with ADA first (log-rank test P = 0.42 and P = 0.74, respectively). In addition, no significant difference was observed in the rate of occurrence of events associated with ineffectiveness (modification of anti-tumor necrosis factor treatment including intensification, switch, discontinuation, or surgery) between the patient groups (log-rank test P = 0.62). The patients treated with IFX first were likely to discontinue the agent due to adverse events, whereas those treated with ADA first were likely to discontinue due to treatment failure or LOR. Conclusions No significant difference was observed in the long-term prognosis between biologic-naive patients with CD who were started treatment with IFX first and ADA first.