Anti-TNFα Treatment After Surgical Resection for Crohn's Disease Is Effective Despite Previous Pharmacodynamic Failure
Anti-TNFα Treatment After Surgical Resection for Crohn's Disease Is Effective Despite Previous Pharmacodynamic Failure
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DOI：
10.1097/mib.0000000000001050
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发表时间：
2017-05-01
影响因子：
4.9
通讯作者：
Shamir, Raanan
中科院分区：
文献类型：
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作者：
Assa, Amit;Bronsky, Jiri;Shamir, Raanan
背景：克罗恩病患者尽管血清药物水平足够(药效学失败)，但抗肿瘤坏死因子α治疗失败，其结果尚不清楚。我们的目的是评估这类接受肠切除的儿童患者，并在术后再次使用相同的抗肿瘤坏死因子α制剂。方法：对接受肠切除并在术后应用抗肿瘤坏死因子α药物治疗的克罗恩病患儿进行回顾性评估。将患者分为术前抗肿瘤坏死因子α药效失败组和术前未接受抗肿瘤坏死因子α治疗的患儿。结果：共纳入53例患儿，其中18例为药效失败组，35例为对照组。肠切除时的中位年龄为14.8岁，其中23名(43%)为女孩。从肠切除到抗肿瘤坏死因子-α治疗的中位时间为8个月(四分位间隔4-14个月)。术后开始抗肿瘤坏死因子-α治疗时，两组患者的临床、实验室和人体测量结果无差异。两组患者在12个月后和随访结束时(1.8年，四分位数间隔1-2.9年)临床缓解的比例相似：药效学失败组和对照组分别为89%和83%，分别为88.5%和80%；P=0.9。在术后14周和12个月的抗肿瘤坏死因子α治疗中，包括内窥镜缓解率和粪便钙保护素，两组间差异无统计学意义。两组在术后抗肿瘤坏死因子α治疗过程中各项指标均有明显改善。结论：小儿克罗恩病患者在药物水平足够的情况下抗肿瘤坏死因子α治疗失败并行肠切除，可再次用相同的药物治疗，术后复发的成功率与单纯抗肿瘤坏死因子治疗的患者相似。
Background: The outcome of patients with Crohn's disease who failed anti-tumor necrosis factor alpha (anti-TNF alpha) therapy despite adequate serum drug levels (pharmacodynamic failure) is unclear. We aimed to assess such pediatric patients who underwent intestinal resection and were re-treated with the same anti-TNF alpha agent postoperatively.Methods: Pediatric patients with Crohn's disease who underwent intestinal resection and were treated with anti-TNF alpha agents postoperatively were assessed retrospectively. Patients were stratified to those with preoperative anti-TNF alpha pharmacodynamic failure and those with no preoperative antiTNF alpha treatment.Results: A total of 53 children were included, 18 with pharmacodynamic failure and 35 controls. Median age at intestinal resection was 14.8 years with 23 (43%) girls. The median time from intestinal resection to anti-TNF alpha initiation was 8 months (interquartile range 4-14 months). At the time of postoperative anti-TNF alpha initiation there were no differences in clinical, laboratory, and anthropometric measures between groups. Similar proportions of patients from both groups were in clinical remission on anti-TNF alpha treatment after 12 months and at the end of follow-up (1.8 years, interquartile range, 1-2.9 years): 89% versus 88.5% and 83% versus 80% for pharmacodynamic failure patients and controls, respectively; P = 0.9. No significant differences were observed at 14 weeks and 12 months of postoperative anti-TNF alpha treatment including endoscopic remission rate and fecal calprotectin. Both groups significantly improved all measures during postoperative anti-TNF alpha treatment.Conclusions: Pediatric patients with Crohn's disease who failed anti-TNF alpha therapy despite adequate drug levels and underwent intestinal resection can be re-treated with the same agent for postoperative recurrence with high success rate similar to that of anti-TNF alpha naive patients.