Limited long-term treatment persistence of first anti-TNF therapy in 538 patients with inflammatory bowel diseases: a 20-year real-world study.
Limited long-term treatment persistence of first anti-TNF therapy in 538 patients with inflammatory bowel diseases: a 20-year real-world study.
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538例炎症性肠病患者首次抗TNF治疗的有限长期治疗持续性：一项20年真实世界研究
DOI：
10.1111/apt.16478
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发表时间：
2021-09
影响因子：
7.6
通讯作者：
Petritsch W
中科院分区：
文献类型：
--
作者：
Blesl A;Binder L;Högenauer C;Wenzl H;Borenich A;Pregartner G;Berghold A;Mestel S;Kump P;Baumann-Durchschein F;Petritsch W
抗TNF抗体是炎症性肠病患者的首选生物治疗方案。评估炎症性肠病患者标准治疗中首次抗肿瘤坏死因子治疗持续时间及影响因素。本研究为单中心回顾性研究，研究对象包括过去20年在该研究中心接受抗TNF治疗的患者。Kaplan‐Meier分析和log‐rank检验用于描述治疗持续性。采用多变量Cox回归分析，探讨治疗失败的危险因素。538例患者（CD，克罗恩病：367例，UC，溃疡性结肠炎：147例，炎症性肠病：24例）纳入研究，中位随访时间为8.1年。整个队列的治疗持续时间中位数（95%置信区间）为2.3年（28[22,38]个月），近一半的患者在2年内退出治疗。男性患者治疗时间较女性患者长（男性37[25,48]个月，女性23[14,33]个月，P = 0.002）。与UC相比，CD的治疗持续时间更长（CD: 39[30,50]个月，UC: 13[9,19]个月，P < 0.001）， CD患者使用阿达木单抗比使用英夫利昔单抗持续时间更长（阿达木单抗：67[55,95]个月，英夫利昔单抗：19[14,31]个月，P < 0.001）。治疗失败（52%）和副作用（25%）是退出治疗的最常见原因；14%因缓解而退出。女性被认为是UC治疗失败的独立预测因素（风险比[CI]: 1.73[1.02‐2.92],P = 0.04）。炎症性肠病患者首次抗TNF治疗的长期持续治疗受到限制，主要是由于治疗失败和副作用。在随访结束时，只有29%的患者仍然接受了第一次抗TNF治疗。在男性、克罗恩病患者和阿达木单抗治疗克罗恩病患者中，可以观察到更长的治疗持续时间。
Anti‐TNF antibodies were the first biologic treatment option for patients with inflammatory bowel diseases. To assess length of treatment persistence of first anti‐TNF therapy and influencing factors used in the standard care of patients with inflammatory bowel diseases. Single‐centre, retrospective study from a register including patients who received anti‐TNF therapy in the last 20 years at the study centre. Kaplan‐Meier analysis with log‐rank test was used to describe treatment persistence. With multivariable Cox regression analysis, risk factors for treatment failure were investigated. Five hundred thirty‐eight patients (CD, Crohn's disease: 367, UC, ulcerative colitis: 147, inflammatory bowel disease unclassified: 24) with a median follow‐up of 8.1 years were included. Median (95% confidence interval) treatment persistence in the total cohort was 2.3 years (28 [22, 38] months), and nearly half of patients withdrew from treatment within 2 years. Male patients were treated longer than females (male: 37 [25, 48] months, female: 23 [14, 33] months, P = 0.002). Treatment persistence was longer in CD compared to UC (CD: 39 [30, 50] months, UC: 13 [9, 19] months, P < 0.001), and patients with CD remained longer on adalimumab than on infliximab treatment (adalimumab: 67 [55, 95] months, infliximab: 19 [14, 31] months, P < 0.001). Treatment failure (52%) and side effects (25%) were the most common reasons for withdrawal from therapy; 14% withdrew due to remission. Female sex was identified as independent predictor for treatment failure in UC (hazard ratio [CI]: 1.73 [1.02‐2.92], P = 0.04). Long‐term treatment persistence of first anti‐TNF therapy was limited in patients with inflammatory bowel diseases, primarily due to treatment failure and side effects. At the end of follow‐up, only 29% of patients still received scheduled treatment with the first anti‐TNF. Longer treatment persistence could be observed in males, in patients with Crohn's disease and for adalimumab treatment in Crohn's disease.
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影响因子：
4.1
作者：
Inokuchi, Toshihiro;Takahashi, Sakuma;Okada, Hiroyuki
通讯作者：
Okada, Hiroyuki
影响因子：
7.6
作者：
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影响因子：
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29.4
作者：
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Pollack, Paul F.
影响因子：
7.6
作者：
Colombel, J. -F.;Sandborn, W. J.;Read, H.
通讯作者：
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