Ferges William, Rampertab Saroja Devi, Shafqet Muhammad, Salimi Qasim, You Geoffrey, Yousefzadeh Eleazer, Cheng Jerry Q, Das Kiron M
Division of Gastroenterology, Medicine, Biochemistry and Molecular Biology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.
J Clin Gastroenterol. 2016 Apr;50(4):326-30. doi: 10.1097/MCG.0000000000000338.
Our aim was to identify and compare the effectiveness of antitumor necrosis factor biologics when used as initial agents and when used in succession for the treatment of moderate to severe Crohn's disease (CD).
Studies directly comparing the efficacy of biologics are lacking. When one biologic loses efficacy, patients are often treated with an alternate biologic. The effectiveness of this strategy has not been thoroughly investigated.
This is a retrospective cohort study from a database of 153 patients with CD treated with infliximab, adalimumab, or certolizumab pegol. Response rates determined by physician global assessment were compared between biologics when given as initial agents and after failure of 1 or 2 prior biologics.
There were no significant differences in response between infliximab (64.5%), adalimumab (60.0%), and certolizumab pegol (66.7%) when given as initial biologics. As second-line or third-line agents after prior biologic failure, there was a trend toward increased response with infliximab (83.3%) versus adalimumab (52.7%) and certolizumab pegol (59.4%); however, this did not meet statistical significance. After failure or loss of response of 2 previous biologics, use of a third biologic was still effective with a response rate of 54.2%.
All 3 biologics have similar efficacy in the treatment of CD when given as initial agents. Infliximab has a trend toward increased response after prior biologic failure; however, this did not meet statistical significance. Even after loss of response or failure of 2 previous biologics, trial of a third alternate biologic is an effective strategy.
我们的目的是确定并比较抗肿瘤坏死因子生物制剂作为初始治疗药物以及序贯用于治疗中度至重度克罗恩病（CD）时的有效性。
缺乏直接比较生物制剂疗效的研究。当一种生物制剂失去疗效时，患者通常会换用另一种生物制剂。这一策略的有效性尚未得到充分研究。
这是一项回顾性队列研究，数据来自153例接受英夫利昔单抗、阿达木单抗或赛妥珠单抗治疗的CD患者数据库。比较了生物制剂作为初始治疗药物以及在先前1种或2种生物制剂治疗失败后使用时，由医生整体评估确定的缓解率。
作为初始生物制剂使用时，英夫利昔单抗（64.5%）、阿达木单抗（60.0%）和赛妥珠单抗（66.7%）的缓解率无显著差异。在先前生物制剂治疗失败后作为二线或三线药物使用时，英夫利昔单抗（83.3%）与阿达木单抗（52.7%）和赛妥珠单抗（59.4%）相比有缓解率增加的趋势；然而，这未达到统计学显著性。在先前2种生物制剂治疗失败或失去疗效后，使用第三种生物制剂仍有效，缓解率为54.2%。
所有3种生物制剂作为初始治疗药物治疗CD时疗效相似。英夫利昔单抗在先前生物制剂治疗失败后有缓解率增加的趋势；然而，这未达到统计学显著性。即使在先前2种生物制剂失去疗效或治疗失败后，试用第三种替代生物制剂仍是一种有效的策略。
