Eberhardson M, Söderling J K, Neovius M, Cars T, Myrelid P, Ludvigsson J F, Askling J, Ekbom A, Olén O
Danderyd's Hospital, Stockholm, Sweden.
Karolinska Institutet, Stockholm, Sweden.
Aliment Pharmacol Ther. 2017 Sep;46(6):589-598. doi: 10.1111/apt.14224. Epub 2017 Jul 28.
TNF inhibitors (TNFi) have been shown to reduce the need for surgery in Crohn's disease, but few studies have examined their effect beyond the first year of treatment.
To conduct a register-based observational cohort study in Sweden 2006-2014 to investigate the risk of bowel resection in bowel surgery naïve TNFi-treated Crohn's disease patients and whether patients on TNFi ≥12 months are less likely to undergo bowel resection than patients discontinuing treatment before 12 months.
We identified all individuals in Sweden with Crohn's disease through the Swedish National Patient Register 1987-2014 and evaluated the incidence of bowel resection after first ever dispensation of adalimumab or infliximab from 2006 and up to 7 years follow-up.
We identified 1856 Crohn's disease patients who had received TNFi. Among these patients, 90% treatment retention was observed at 6 months after start of TNFi and 65% remained on the drug after 12 months. The cumulative rates of surgery in Crohn's disease patients exposed to TNFi years 1-7 were 7%, 13%, 17%, 20%, 23%, 25% and 28%. Rates of bowel resection were similar between patients with TNFi survival <12 months and ≥12 months respectively (P=.27). No predictors (eg, sex, age, extension or duration of disease) for bowel resection were identified.
The risk of bowel resection after start of anti-TNF treatment is higher in regular health care than in published RCTs. Patients on sustained TNFi treatment beyond 12 months have bowel resection rates similar to those who discontinue TNFi treatment earlier.
肿瘤坏死因子抑制剂（TNFi）已被证明可减少克罗恩病患者的手术需求，但很少有研究考察其治疗一年后的效果。
在瑞典开展一项基于注册登记的观察性队列研究，研究对象为2006 - 2014年首次接受TNFi治疗且未接受过肠道手术的克罗恩病患者，以调查肠道切除风险，以及接受TNFi治疗≥12个月的患者与在12个月前停药的患者相比，接受肠道切除的可能性是否更低。
我们通过瑞典国家患者注册登记系统识别出1987 - 2014年瑞典所有克罗恩病患者，并评估了2006年首次使用阿达木单抗或英夫利昔单抗后直至7年随访期内肠道切除的发生率。
我们识别出1856例接受过TNFi治疗的克罗恩病患者。在这些患者中，开始使用TNFi后6个月时的治疗保留率为90%，12个月后仍有65%的患者继续使用该药物。1 - 7年接受TNFi治疗的克罗恩病患者的累积手术率分别为7%、13%、17%、20%、23%、25%和28%。TNFi治疗存活时间<12个月和≥12个月的患者肠道切除率分别相似（P = 0.27）。未发现肠道切除的预测因素（如性别、年龄、疾病范围或病程）。
常规医疗中抗TNF治疗开始后肠道切除的风险高于已发表的随机对照试验。持续接受TNFi治疗超过12个月的患者肠道切除率与早期停用TNFi治疗的患者相似。
