Inflammatory Intestinal Diseases最新文献

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A Retrospective Observational Study of Patterns of Biologic Drug Change in Inflammatory Bowel Disease 炎症性肠病生物药物更换模式的回顾性观察研究

Inflammatory Intestinal Diseases

Pub Date : 2024-03-12 DOI: 10.1159/000538250

M. Mosli

Introduction: Multiple therapies are currently available for inflammatory bowel disease (IBD); it is therefore crucial to understand patterns of drug change. This study aimed to examine the patterns of biological drug change and identify predictors of change in patients with IBD. Materials and Methods: We performed a retrospective study of patients diagnosed with IBD who were initiated on treatment with biologics between June 2017 and October 2022. The study's primary objective was to describe biologics drug change patterns. Secondary outcomes included identifying predictors of drug change. Results: 910 patients were screened; 475 patients were eligible. 319 (67%) had Crohn’s disease (CD), and 253 (53.3%) were males. The most selected first and second choice of biologic was adalimumab (58.2% and 39.1%, p<0.001) and infliximab (37.6% and 48.9%, p=0.004) for both CD and UC, respectively. On multiple regression analysis, a history of venous thromboembolism (VTE) (OR=3.60, p=0.025) and smoking (OR=0.34, p=0.026) were associated with drug change for all patients. When stratified by disease subtype, drug change was associated with a diagnosis made between age 17 and 40 years (OR=0.46, p=0.024) and extra intestinal manifestations (EIMs) (OR=2.07, p=0.015) in CD while selecting vedolizumab as first biologic (OR=0.30, p=0.041), male gender (OR=2.40, p=0.043), and history of VTE (OR=7.32, p=0.031) were associated with drug change in ulcerative colitis (UC). Conclusions: Despite introducing several new biologics, anti-TNF therapies remain the preferred first and second choice of biologics for patients with IBD. Multiple predictors of drug change over time exist for both diseases. Selecting vedolizumab as the first biologic for UC is associated with a lower risk of drug change.

简介：炎症性肠病（IBD）目前有多种疗法，因此了解药物变化的模式至关重要。本研究旨在研究 IBD 患者的生物药物变化模式，并确定药物变化的预测因素。材料与方法：我们对 2017 年 6 月至 2022 年 10 月期间开始接受生物制剂治疗的 IBD 患者进行了一项回顾性研究。研究的首要目标是描述生物制剂药物的变化模式。次要结果包括确定药物变化的预测因素。研究结果共筛选出 910 名患者，其中 475 名符合条件。319人（67%）患有克罗恩病（CD），253人（53.3%）为男性。CD和UC患者选择最多的第一和第二生物制剂分别是阿达木单抗（58.2%和39.1%，p<0.001）和英夫利昔单抗（37.6%和48.9%，p=0.004）。在多元回归分析中，静脉血栓栓塞（VTE）病史（OR=3.60，p=0.025）和吸烟（OR=0.34，p=0.026）与所有患者的换药相关。按疾病亚型分层时，CD 患者的换药与诊断年龄在 17-40 岁之间（OR=0.46，p=0.024）和肠道外表现（EIMs）（OR=2.07，p=0.015），而在溃疡性结肠炎（UC）中，选择维多珠单抗作为首个生物制剂（OR=0.30，P=0.041）、男性性别（OR=2.40，P=0.043）和VTE病史（OR=7.32，P=0.031）与换药有关。结论：尽管引入了几种新的生物制剂，抗肿瘤坏死因子疗法仍是 IBD 患者首选和次选的生物制剂。这两种疾病都存在药物随时间变化的多种预测因素。选择韦多珠单抗作为治疗 UC 的首选生物制剂与较低的换药风险有关。

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