{"title":"一个全国性队列中的生物惰性溃疡性结肠炎患者开始使用阿达木单抗五年后的临床病程","authors":"Ramaswamy Sundararajan, Manthankumar Patel, Janak Bahirwani, Chinmay Trivedi, Nadim Mahmud, Nabeel Khan","doi":"10.1093/crocol/otae046","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is limited data on the long-term clinical outcomes of bio-naïve ulcerative colitis (UC) patients who are initiated on adalimumab (ADA). Our study aims to evaluate the clinical course of a nationwide cohort of bio naïve UC patients who were started on ADA, and then followed for 5 years after initiation of the drug.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the US Veteran Affairs Healthcare System (VAHS). Bio naïve UC patients were followed for 5 years after initiation of ADA. The primary outcome was to determine the time to discontinuation of ADA and if patients achieved endoscopic remission by the end of follow-up.</p><p><strong>Results: </strong>A total of 387 patients were included among whom 193 (49.87%) had pancolitis. The highest rate of ADA discontinuation was within the first year, with the elderly having a higher rate of discontinuation (HR 1.67, 95% CI: 1.14-2.45) and those on concomitant immunomodulators having a lower rate of discontinuation (HR 0.70, 95% CI: 0.48-1.03). In total, 125 (32.30%) patients remained on ADA at the end of their maximum follow-up. 54 (43.90%) achieved endoscopic remission.</p><p><strong>Conclusion: </strong>Among bio-naive UC patients who were started on ADA, a third were still on the drug at the end of 5 years and half had endoscopic remission. The rate of discontinuation was highest within the first year of initiation, but patients continued to stop the drug over the course of follow-up.</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345511/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinical Course of Bio Naive Ulcerative Colitis Patients Five Years After Initiation of Adalimumab in a Nationwide Cohort.\",\"authors\":\"Ramaswamy Sundararajan, Manthankumar Patel, Janak Bahirwani, Chinmay Trivedi, Nadim Mahmud, Nabeel Khan\",\"doi\":\"10.1093/crocol/otae046\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is limited data on the long-term clinical outcomes of bio-naïve ulcerative colitis (UC) patients who are initiated on adalimumab (ADA). Our study aims to evaluate the clinical course of a nationwide cohort of bio naïve UC patients who were started on ADA, and then followed for 5 years after initiation of the drug.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the US Veteran Affairs Healthcare System (VAHS). Bio naïve UC patients were followed for 5 years after initiation of ADA. The primary outcome was to determine the time to discontinuation of ADA and if patients achieved endoscopic remission by the end of follow-up.</p><p><strong>Results: </strong>A total of 387 patients were included among whom 193 (49.87%) had pancolitis. The highest rate of ADA discontinuation was within the first year, with the elderly having a higher rate of discontinuation (HR 1.67, 95% CI: 1.14-2.45) and those on concomitant immunomodulators having a lower rate of discontinuation (HR 0.70, 95% CI: 0.48-1.03). In total, 125 (32.30%) patients remained on ADA at the end of their maximum follow-up. 54 (43.90%) achieved endoscopic remission.</p><p><strong>Conclusion: </strong>Among bio-naive UC patients who were started on ADA, a third were still on the drug at the end of 5 years and half had endoscopic remission. The rate of discontinuation was highest within the first year of initiation, but patients continued to stop the drug over the course of follow-up.</p>\",\"PeriodicalId\":10847,\"journal\":{\"name\":\"Crohn's & Colitis 360\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-08-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345511/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Crohn's & Colitis 360\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/crocol/otae046\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Crohn's & Colitis 360","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/crocol/otae046","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:关于开始使用阿达木单抗(ADA)的生化免疫缺陷型溃疡性结肠炎(UC)患者的长期临床疗效的数据十分有限。我们的研究旨在评估全国范围内开始使用阿达木单抗的生化免疫缺陷型溃疡性结肠炎患者的临床过程,并在开始用药后随访5年:我们利用美国退伍军人事务医疗保健系统(VAHS)开展了一项回顾性队列研究。我们在美国退伍军人事务医疗保健系统(VAHS)中开展了一项回顾性队列研究。在开始使用 ADA 后,我们对未接受生物治疗的 UC 患者进行了为期 5 年的随访。主要结果是确定停用 ADA 的时间,以及随访结束时患者是否达到内镜下缓解:结果:共纳入了 387 名患者,其中 193 人(49.87%)患有胰腺炎。第一年内停用 ADA 的比例最高,老年人的停用率较高(HR 1.67,95% CI:1.14-2.45),同时服用免疫调节剂的患者停用率较低(HR 0.70,95% CI:0.48-1.03)。在最长随访结束时,共有 125 名(32.30%)患者仍在服用 ADA。54人(43.90%)获得了内镜下缓解:结论:在开始服用 ADA 的生化免疫性 UC 患者中,三分之一的患者在 5 年后仍在服药,半数患者获得了内镜下缓解。停药率在开始用药的第一年内最高,但在随访过程中,患者仍在继续停药。
Clinical Course of Bio Naive Ulcerative Colitis Patients Five Years After Initiation of Adalimumab in a Nationwide Cohort.
Background: There is limited data on the long-term clinical outcomes of bio-naïve ulcerative colitis (UC) patients who are initiated on adalimumab (ADA). Our study aims to evaluate the clinical course of a nationwide cohort of bio naïve UC patients who were started on ADA, and then followed for 5 years after initiation of the drug.
Methods: We conducted a retrospective cohort study using the US Veteran Affairs Healthcare System (VAHS). Bio naïve UC patients were followed for 5 years after initiation of ADA. The primary outcome was to determine the time to discontinuation of ADA and if patients achieved endoscopic remission by the end of follow-up.
Results: A total of 387 patients were included among whom 193 (49.87%) had pancolitis. The highest rate of ADA discontinuation was within the first year, with the elderly having a higher rate of discontinuation (HR 1.67, 95% CI: 1.14-2.45) and those on concomitant immunomodulators having a lower rate of discontinuation (HR 0.70, 95% CI: 0.48-1.03). In total, 125 (32.30%) patients remained on ADA at the end of their maximum follow-up. 54 (43.90%) achieved endoscopic remission.
Conclusion: Among bio-naive UC patients who were started on ADA, a third were still on the drug at the end of 5 years and half had endoscopic remission. The rate of discontinuation was highest within the first year of initiation, but patients continued to stop the drug over the course of follow-up.