Long-term treatment persistence and influencing factors of tumor necrosis factor α antagonists and vedolizumab in patients with inflammatory bowel diseases
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.
tumor necrosis factor a antagonistvedolizumabinflammatory bowel diseasestreatment persistence
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