Durability of the First Biologic in Patients with Crohn's Disease: A Nationwide Study from the epi-IIRN.

IF 8.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Journal of Crohns & Colitis Pub Date : 2024-01-27 DOI:10.1093/ecco-jcc/jjad121
Ohad Atia, Chagit Friss, Gili Focht, Ramit Magen Rimon, Natan Ledderman, Shira Greenfeld, Amir Ben-Tov, Yiska Loewenberg Weisband, Eran Matz, Yuri Gorelik, Yehuda Chowers, Iris Dotan, Dan Turner
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Abstract

Background: In this nationwide study we aimed to compare the durability of the first initiated biologic in Crohn's disease [CD], stratified by monotherapy and combotherapy.

Methods: We used data from the epi-IIRN cohort, which includes 98% of the Israeli inflammatory bowel disease population [2005-2020]. Durability was defined as consistent treatment without surgery or added medications [except for combination therapy with thiopurines or methotrexate]. All comparisons were based on stringent propensity-score matching and paired time-to-event analyses.

Results: A total of 19 264 patients with CD were included, of whom 7452 [39%] received biologics with a median follow-up of 6.8 years (interquartile range [IQR] 3.6-10.7). Time to biologics decreased gradually from 6.7 years [IQR 2.7-10.4] in 2005 to 0.2 years [0.07-0.23] in 2020. The durability of the first biologic after 1 and 3 years was higher with adalimumab monotherapy [88%/61%] than vedolizumab monotherapy [81%/59%; n = 394 matched patients, p = 0.04] and similar between infliximab monotherapy and vedolizumab monotherapy [65%/43%; n = 182 matched patients, p = 0.1]. Durability was higher in adalimumab monotherapy vs infliximab monotherapy [83%/62% vs 71%/48% at 1/3 years; p <0.001] and it was similar in adalimumab monotherapy vs infliximab combotherapy [87%/63% vs 80%/58%, respectively; p = 0.1]. Durability was higher in combotherapy compared with monotherapy for both infliximab [85%/64% vs 67%/43%, respectively; n = 496 matched pairs, p <0.001], and adalimumab [93%/76% vs 82%/62%, respectively; n = 540 matched pairs, p <0.001].

Conclusion: Durability of the first biologic in CD was highest for adalimumab monotherapy. Combotherapy further increased the durability of adalimumab and infliximab. Unless otherwise indicated, our data may support using anti-tumour necrosis factors [TNFs] as first-line biologics in CD, particularly adalimumab if monotherapy is advised.

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克罗恩病患者首次使用生物制剂的持久性:epi-IIRN 全国性研究。
背景在这项全国性研究中,我们旨在比较克罗恩病[CD]首次使用生物制剂的耐久性,并按单一疗法和联合疗法进行分层:我们使用了 epi-IIRN 队列的数据,其中包括 98% 的以色列炎症性肠病患者(2005-2020 年)。耐久性的定义是在不进行手术或添加药物的情况下持续治疗[硫嘌呤或甲氨蝶呤联合疗法除外]。所有比较均基于严格的倾向分数匹配和配对时间-事件分析:共纳入19 264名CD患者,其中7 452人[39%]接受了生物制剂治疗,中位随访时间为6.8年(四分位数间距[IQR] 3.6-10.7)。使用生物制剂的时间从2005年的6.7年[IQR 2.7-10.4]逐渐降至2020年的0.2年[0.07-0.23]。阿达木单抗单药治疗[88%/61%]在1年和3年后首次使用生物制剂的耐久性高于维多珠单抗单药治疗[81%/59%;n = 394名匹配患者,p = 0.04],英夫利西单药治疗与维多珠单抗单药治疗的耐久性相似[65%/43%;n = 182名匹配患者,p = 0.1]。阿达木单抗单药治疗的耐久性高于英夫利西单药治疗[1/3年时,阿达木单抗单药治疗的耐久性为83%/62%,英夫利西单药治疗的耐久性为71%/48%;P阿达木单抗单药治疗CD的耐久性最高。联合疗法进一步提高了阿达木单抗和英夫利西单抗的耐久性。除非另有说明,我们的数据可能支持将抗肿瘤坏死因子[TNFs]作为CD的一线生物制剂,尤其是阿达木单抗(如果建议单药治疗)。
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来源期刊
Journal of Crohns & Colitis
Journal of Crohns & Colitis 医学-胃肠肝病学
CiteScore
15.50
自引率
7.50%
发文量
1048
审稿时长
1 months
期刊介绍: Journal of Crohns and Colitis is concerned with the dissemination of knowledge on clinical, basic science and innovative methods related to inflammatory bowel diseases. The journal publishes original articles, review papers, editorials, leading articles, viewpoints, case reports, innovative methods and letters to the editor.
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