Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Clin Gastroenterol Hepatol. 2017 Jul;15(7):1061-1070.e1. doi: 10.1016/j.cgh.2017.01.035. Epub 2017 Feb 24.
BACKGROUND & AIMS: Anti-tumor necrosis factor (anti-TNF) agents are effective treatments for Crohn's disease (CD) and ulcerative colitis (UC). We aimed to determine their patterns of use and changes in these patterns over time, as well as use of immunomodulators and corticosteroids before anti-TNF therapy for persons with inflammatory bowel diseases.
We used the University of Manitoba IBD Epidemiology Database to identify all anti-TNF users with CD and UC from 2001 through 2014. We assessed changes in the prevalence and incidence of anti-TNF use during different time periods (April 2001-March 2005, April 2005-March 2009, or April 2009-March 2013). We also characterized patterns of corticosteroid use, corticosteroid dependence, and immunomodulator use before anti-TNF administration and determined how these changed over time. The primary end point was change in time to first receipt of anti-TNF among the different time periods.
We identified 950 persons (761 with CD and 189 with UC) who received anti-TNF agents. The cumulative prevalence of persons with current or prior anti-TNF exposure in 2014 was 20.4% for CD and 6.0% for UC. In 2014 the cumulative incidence values of anti-TNF exposure within 5 years of diagnosis were 23.4% for patients with CD and 7.8% for patients with UC. Most users of anti-TNF agents had evidence of corticosteroid dependence (more than 2 g prednisone within any 12-month period) before initiation of anti-TNF therapy. Cumulative corticosteroid exposure before anti-TNF use decreased over time for patients with UC, but not significantly for patients with CD. There was no increase over time in the use of concomitant immunomodulators with anti-TNF therapy.
Use of anti-TNF agents increased from 2001 through 2014, with a concomitant significant decrease in cumulative use of corticosteroids before anti-TNF therapy for patients with UC. However, there has been no reduction in cumulative use of corticosteroids before anti-TNF therapy for patients with CD and no change in use of immunomodulators by patients with CD. These findings indicate a continuing need for optimization of anti-TNF therapy for patients with inflammatory bowel disease.
抗肿瘤坏死因子（anti-TNF）药物是治疗克罗恩病（CD）和溃疡性结肠炎（UC）的有效方法。我们旨在确定炎症性肠病患者在接受抗 TNF 治疗之前，TNF 抑制剂的使用模式及其随时间的变化，以及免疫调节剂和皮质类固醇的使用情况。
我们使用马尼托巴大学 IBD 流行病学数据库，从 2001 年至 2014 年期间确定所有接受 CD 和 UC 治疗的抗 TNF 使用者。我们评估了不同时间段（2001 年 4 月至 2005 年 3 月、2005 年 4 月至 2009 年 3 月或 2009 年 4 月至 2013 年 3 月）内抗 TNF 使用率的变化。我们还描述了皮质类固醇使用、皮质类固醇依赖和免疫调节剂在接受抗 TNF 治疗前的使用模式，并确定了这些模式随时间的变化情况。主要终点是不同时间段内首次接受抗 TNF 治疗的时间变化。
我们确定了 950 名（761 名 CD 和 189 名 UC）接受抗 TNF 药物治疗的患者。2014 年，当前或既往接受抗 TNF 治疗的患者累积患病率为 CD 患者的 20.4%，UC 患者的 6.0%。2014 年，CD 患者诊断后 5 年内抗 TNF 暴露的累积发生率为 23.4%，UC 患者为 7.8%。大多数接受抗 TNF 药物治疗的患者在开始抗 TNF 治疗前有皮质类固醇依赖的证据（12 个月内超过 2 g 泼尼松）。UC 患者在接受抗 TNF 治疗前的皮质类固醇暴露量随时间减少，但 CD 患者没有显著减少。随着时间的推移，与抗 TNF 治疗同时使用的免疫调节剂并没有增加。
抗 TNF 药物的使用从 2001 年至 2014 年增加，同时 UC 患者在接受抗 TNF 治疗前皮质类固醇的累积使用量显著减少。然而，CD 患者在接受抗 TNF 治疗前皮质类固醇的累积使用量并没有减少，CD 患者使用免疫调节剂的情况也没有改变。这些发现表明，需要进一步优化炎症性肠病患者的抗 TNF 治疗。
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