肿瘤坏死因子α拮抗剂和维得利珠单抗治疗炎症性肠病的持久性及影响因素
Long-term treatment persistence and influencing factors of tumor necrosis factor α antagonists and vedolizumab in patients with inflammatory bowel diseases
陈春燕 1丁振东 1吴巧艳 2朱素燕1
作者信息
- 1. 宁波大学附属第一医院药学部,宁波 315010
- 2. 宁波大学附属第一医院消化科,宁波 315010
- 折叠
摘要
目的 评估炎症性肠病(IBD)患者接受肿瘤坏死因子α(TNF-α)拮抗剂或维得利珠单抗治疗的持久性及治疗失败的危险因素.方法 采用回顾性队列研究方法,收集过去8年内在研究中心接受TNF-α拮抗剂或维得利珠单抗治疗的患者资料.采用Kaplan-Meier法计算治疗持续时间,并使用log-rank检验法进行比较.采用多因素Cox回归分析,探讨治疗失败的危险因素.结果 本研究共纳入210例患者(168例使用TNF-α拮抗剂,42例使用维得利珠单抗),中位治疗时间为3.2年[35(29,50)个月],近一半患者在5年内退出治疗.40岁以上患者的治疗持续时间显著低于年轻患者[＜40岁:39(31,62)个月;≥40岁:25(20,50)个月;P=0.013].生物制剂起始治疗时,基线红细胞沉降率(ESR)＜25 mm·h-1的患者的治疗持续时间要长于基线ESR ≥ 25 mm·h-1的患者(P=0.06).100例终止治疗的患者中,治疗失败患者占56％,疾病缓解患者占18％,因药物不良反应而终止治疗患者占17％.生物制剂起始治疗时的C-反应蛋白水平被确定为TNF-α拮抗剂治疗失败的独立预测因素(HR:1.03,95％CI:1.01～1.04,P=0.009).结论 IBD患者接受生物制剂治疗的长期持久性有限,终止治疗的主要原因是治疗失败、疾病缓解和药物不良反应.
Abstract
AIM To assess the durability of treatment and risk factors for treatment failure in the patients with inflammatory bowel diseases(IBD)receiving tumor necrosis factor α antagonist(anti-TNF)or vedolizumab(VDZ)therapy.METHODS Single-centre,retrospective study from a register including patients who received anti-TNF or VDZ therapy in the last 8 years at the study centre.The Kaplan-Meier method was used to calculate the treatment persistence,and the log-rank method was used for comparison.With multivariable Cox regression analysis,risk factors for treatment failure were investigated.RESULTS Among the 210 patients included,168 received anti-TNF and 42 received VDZ.Median(95％confidence interval)treatment persistence in the total cohort was 3.2 years(35(29,50)months),and nearly half of patients withdrew from treatment within 5 years.The time duration was strikingly decreased in patients who were older than 40 years compared to younger patients(＜40 years:39(31,62)months,≥ 40 years:25(20,50)months,P=0.013).Patients with low erythrocyte sedimentation rate(ESR)concentrations(＜25 mm·h-1)at biologics initiation were treated longer than with a high concentration(≥ 25 mm·h-1)(P=0.06).Among the 100 patients who withdrew from therapy,treatment failure was the condition for 56％,disease remission was the condition for 18％,and adverse drug reactions were the condition for 17％to withdrawal from therapy.C-reactive protein level at biologics initiation was identified as the independent predictor for treatment failure in anti-TNF therapy(HR:1.03,95％CI:1.01-1.04,P=0.009).CONCLUSION Long-term treatment persistence of biologics therapy was limited in patients with IBD,primarily due to treatment failure,remission and adverse drug reactions.
关键词
肿瘤坏死因子α拮抗剂/维得利珠单抗/炎症性肠病/治疗持久性Key words
tumor necrosis factor a antagonist/vedolizumab/inflammatory bowel diseases/treatment persistence引用本文复制引用
基金项目
浙江省医药卫生科技计划项目(2023RC259)
宁波市自然科学基金(2023J166)
出版年
2024
国家科技期刊平台
NSTL
万方数据