Efficacies of first and second tumor necrosis factor inhibitors in refractory ulcerative colitis patients in real-world practice,
Efficacies of first and second tumor necrosis factor inhibitors in refractory ulcerative colitis patients in real-world practice,
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在现实世界中，第一和第二肿瘤坏死因子抑制剂对难治性溃疡性结肠炎患者的疗效，
DOI：
10.1007/s12664-020-01092-1
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
H.
中科院分区：
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作者：
Marutani;Y.;Mizoshita;T.;Sugiyama;T.;Togawa;S.;Katano;T.;Yamada;T.;Hirata;Y.;Kimura;Y.;Miyaki;T.;Inoue;Y.;Suzuki;E.;Sasaki;M.;and Kataoka;H.
背景肿瘤坏死因子-α抑制剂的转换是首次抗肿瘤坏死因子-α治疗失败的难治性溃疡性结肠炎（UC）患者的重要治疗选择，尽管关于这种选择的许多问题仍然没有答案。方法在第一次抗肿瘤坏死因子治疗失败的难治性UC患者中，使用马约评分作为第8周疾病活动性的指标，对α治疗进行检查。治疗前和第8周和第52周的第一个抗肿瘤坏死因子-α治疗的疗效也进行了评估，在现实世界的practice.ResultsThere缓解诱导和维持之间的英夫利昔单抗和阿达木单抗作为第一个抗肿瘤坏死因子-α治疗UC患者没有显着差异。在123例UC患者中，21例（17.1%）更换了肿瘤坏死因子-α抑制剂。分别有8例（38.1%）、4例（19.0%）、7例（33.3%）和2例（9.5%）患者从英夫利西单抗转换为阿达木单抗、从英夫利西单抗转换为戈利木单抗、从阿达木单抗转换为英夫利西单抗和从阿达木单抗转换为戈利木单抗。3例（100%）对首次抗肿瘤坏死因子-α治疗不耐受，5例（41.7%）首次抗肿瘤坏死因子-α治疗无效，和1（20.0%）首次抗肿瘤坏死因子-α治疗无改善的患者在第8周时临床缓解。α抑制剂对首次抗肿瘤坏死因子-α治疗不耐受和无效的难治性UC患者更有效，而对首次抗肿瘤坏死因子-α治疗无改善的患者更有效。抗肿瘤坏死因子-α治疗原发性失败的患者应改用另一类药物。
BackgroundSwitching tumor necrosis factor-α inhibitors is an important treatment option for refractory ulcerative colitis (UC) patients who fail the first anti-tumor necrosis factor-α therapy, although many questions about this option remain unanswered.MethodsThe efficacy of the second anti-tumor necrosis factor-α therapy in refractory UC patients who failed the first anti-tumor necrosis factor-α therapy was examined using the Mayo score as a measure of disease activity at week 8. The efficacy of the first anti-tumor necrosis factor-α therapy before treatment and at weeks 8 and 52 was also evaluated in real-world practice.ResultsThere were no significant differences in remission induction and maintenance between infliximab and adalimumab as the first anti-tumor necrosis factor-α therapy in UC patients. Of 123 UC patients, 21 (17.1%) switched tumor necrosis factor-α inhibitors. Eight (38.1%), 4 (19.0%), 7 (33.3%), and 2 (9.5%) patients switched from infliximab to adalimumab, infliximab to golimumab, adalimumab to infliximab, and adalimumab to golimumab, respectively. Three (100%) with intolerance to the first anti-tumor necrosis factor-α therapy, 5 (41.7%) with loss of response to the first anti-tumor necrosis factor-α therapy, and 1 (20.0%) with no improvement with the first anti-tumor necrosis factor-α therapy had clinical remission at week 8.ConclusionsSwitching tumor necrosis factor-α inhibitors is more effective for refractory UC patients who are intolerant and lose response to the first anti-tumor necrosis factor-α therapy rather than for those showing no improvement with the first anti-tumor necrosis factor-α therapy. Patients with primary failure of anti-tumor necrosis factor-α therapy should be switched to another class of drug.