Prophylactic Antitubercular Therapy Is Associated With Accelerated Disease Progression in Patients With Crohn's Disease Receiving Anti-TNF Therapy: A Retrospective Multicenter Study.
Prophylactic Antitubercular Therapy Is Associated With Accelerated Disease Progression in Patients With Crohn's Disease Receiving Anti-TNF Therapy: A Retrospective Multicenter Study.
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DOI：
10.14309/ctg.0000000000000493
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发表时间：
2022-06-01
影响因子：
3.6
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中科院分区：
文献类型：
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在接受抗肿瘤坏死因子（抗TNF）治疗的克罗恩病（CD）患者中，预防性抗结核治疗（ATT）被广泛使用。然而，抗结核药物已被证明具有促纤维化作用。我们的目的是评估ATT是否加速接受抗TNF治疗的CD患者的疾病进展。在存在炎症行为（B1）并接受抗TNF药物治疗的CD患者中进行了一项回顾性、多中心研究。疾病进展定义为狭窄（B2）或穿透（B3）表型的发展。ATT使用者与非ATT使用者的倾向评分匹配。生存和多变量考克斯分析用于确定与疾病进展相关的因素。我们招募了441名患者，包括295名ATT使用者和146名非ATT使用者，中位随访时间为3.15年（四分位距：1.6-4.7）。ATT组在1年、3年、5年和10年随访后的累积疾病进展率分别持续高于非ATT组（P = 0.031）。多变量考克斯分析使用整体（风险比= 2.22; 95%置信区间：1.11-4.48; P = 0.025）和倾向评分匹配队列（风险比= 2.35; 95%置信区间：1.07-5.14; P = 0.033）将ATT确定为疾病进展的独立风险因素。在亚组分析中，接受ATT ≥4.5个月的患者的疾病进展率显著高于接受ATT <4.5个月（P = 0.005）和非ATT治疗（P = 0.036）的患者。持续时间超过4.5个月的预防性ATT与接受抗TNF治疗的CD患者的疾病进展相关。
Prophylactic antitubercular therapy (ATT) is widely prescribed in patients with Crohn's disease (CD) receiving antitumor necrosis factor (anti-TNF) treatment. However, antitubercular agents have been demonstrated to possess profibrotic effects. We aimed to evaluate whether ATT accelerated disease progression in patients with CD receiving anti-TNF treatment. A retrospective, multicenter study was performed in CD patients presented with inflammatory behavior (B1) and treated with anti-TNF agents. Disease progression was defined as the development of a stricturing (B2) or penetrating (B3) phenotype. ATT users were propensity score-matched with non-ATT users. Survival and multivariable Cox analyses were used to identify factors associated with disease progression. We enrolled 441 patients, including 295 ATT users and 146 non-ATT users, with a median follow-up of 3.15 years (interquartile range: 1.6–4.7). The cumulative rates of disease progression in the ATT group were constantly higher than those in the non-ATT group after 1-, 3-, 5-, and 10-year follow-ups, respectively (P = 0.031). Multivariable Cox analysis identified ATT as an independent risk factor for disease progression using both the whole (hazard ratio = 2.22; 95% confidence interval: 1.11–4.48; P = 0.025) and propensity score-matched cohorts (hazard ratio = 2.35; 95% confidence interval: 1.07–5.14; P = 0.033). In subgroup analysis, patients receiving ATT ≥4.5 months had a significantly higher rate of disease progression compared with patients receiving ATT <4.5 months (P = 0.005) and non-ATT treatment (P = 0.036). Prophylactic ATT with duration over 4.5 months was associated with disease progression in patients with CD receiving anti-TNF treatment.
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