瑞士炎症性肠病队列研究中抗TNF治疗炎症性肠病肠外表现的研究
Anti-TNF Treatment for Extraintestinal Manifestations of Inflammatory Bowel Disease in the Swiss IBD Cohort Study.
作者信息
Vavricka Stephan R, Gubler Martin, Gantenbein Claudine, Spoerri Muriel, Froehlich Florian, Seibold Frank, Protic Marijana, Michetti Pierre, Straumann Alex, Fournier Nicolas, Juillerat Pascal, Biedermann Luc, Zeitz Jonas, Misselwitz Benjamin, Scharl Michael, Heinrich Henriette, Manser Christine N, Safroneeva Ekaterina, Raja Ali Raja Affendi, Rogler Gerhard, Schoepfer Alain M, Greuter Thomas
机构信息
1Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, Switzerland; 2Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; 3Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland; 4Division of Gastroenterology and Hepatology, University Hospital Lausanne-CHUV, Lausanne, Switzerland; 5Division of Gastroenterology, Lindenhof Spital, Bern, Switzerland; 6Division of Gastroenterology and Hepatology, Spital Tiefenau, Bern, Switzerland; 7Crohn and Colitis Center, Clinique La Source-Beaulieu, Lausanne, Switzerland; 8Praxis Römerhof, Olten, Switzerland; 9Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland; 10Department of Gastroenterology, Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland; 11Department of Gastroenterology, See Spital, Horgen, Switzerland; 12Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; and 13Division of Gastroenterology, The National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia.
出版信息
Inflamm Bowel Dis. 2017 Jul;23(7):1174-1181. doi: 10.1097/MIB.0000000000001109.
BACKGROUND
Extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) are frequently observed. Little is known about the efficacy of anti-tumor necrosis factor (TNF) in EIM management. We assessed the effect of 3 anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) on EIM evolution.
METHODS
Data on 1249 patients from the Swiss IBD Cohort Study (SIBDCS) were analyzed. All EIMs were diagnosed by relevant specialists. Response was classified into improvement, stable disease, and clinical worsening based on the physician's interpretation.
RESULTS
Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF. A total of 299 treatments were started for 355 EIMs. Patients with EIM were significantly more often treated with anti-TNF compared with those without EIM (58.2% versus 21.0%, P < 0.001). Infliximab was the most frequently used drug (63.2%). In more than 71.8%, a clinical response of the underlying EIM to anti-TNF therapy was observed. In 92 patients (43.2%), anti-TNF treatments were started for the purpose of treating EIM rather than IBD. Response rates to anti-TNF were generally good and best for psoriasis, aphthous stomatitis, uveitis, and peripheral arthritis. In 11 patients, 14 EIM occurred under anti-TNF treatment.
CONCLUSIONS
Anti-TNF was frequently used among patients with EIM. In more than 40%, anti-TNF treatments are started to treat EIM rather than IBD. Given the good response rates, anti-TNF seems to be a valuable option in the treatment of EIM, whereas appearance of EIM under anti-TNF does not seem to be a source of considerable concern.
背景
炎症性肠病（IBD）患者的肠外表现（EIMs）较为常见。关于抗肿瘤坏死因子（TNF）在EIM管理中的疗效，人们了解甚少。我们评估了3种抗TNF药物（英夫利昔单抗、阿达木单抗和聚乙二醇化赛妥珠单抗）对EIM演变的影响。
方法
分析了来自瑞士IBD队列研究（SIBDCS）的1249例患者的数据。所有EIM均由相关专科医生诊断。根据医生的判断，将反应分为改善、疾病稳定和临床恶化。
结果
在366例至少有1种EIM的患者中，213例（58.2%）曾接受抗TNF治疗。针对355种EIM共开始了299次治疗。与无EIM的患者相比，有EIM的患者接受抗TNF治疗的频率显著更高（58.2%对21.0%，P<0.001）。英夫利昔单抗是最常用的药物（63.2%）。超过71.8%的患者观察到基础EIM对抗TNF治疗有临床反应。在92例患者（43.2%）中，开始抗TNF治疗是为了治疗EIM而非IBD。抗TNF的反应率总体良好，对银屑病、阿弗他口炎、葡萄膜炎和外周关节炎的效果最佳。11例患者在抗TNF治疗期间出现了14种EIM。
结论
抗TNF在有EIM的患者中经常使用。超过40%的抗TNF治疗是为了治疗EIM而非IBD。鉴于良好的反应率，抗TNF似乎是治疗EIM的一个有价值的选择，而抗TNF治疗期间EIM的出现似乎并非令人担忧的主要原因。
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