Department of Gastroenterology, Barts Health NHS Trust, London, United Kingdom.
IBD Unit, Complesso Integrato Columbus, Gemelli Hospital Catholic University Foundation, Rome, Italy.
Dig Liver Dis. 2017 Oct;49(10):1086-1091. doi: 10.1016/j.dld.2017.07.010. Epub 2017 Aug 1.
Inflammatory bowel disease (IBD) is refractory to treatment in one-half of patients.
To evaluate the occurrence of suboptimal therapy among patients with IBD treated with tumor necrosis factor antagonists (anti-TNFs).
A multinational chart review in Europe and Canada was conducted among IBD patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) who initiated anti-TNF therapy between 2009 and 2013. The primary endpoint was the cumulative incidence of suboptimal therapy during a two-year follow-up period, defined by the presence of the following indicators: dose escalation, discontinuation, switching, non-biologic therapy escalation, or surgery.
The study included 1195 anti-TNF initiators (538 UC and 657 CD). The majority of patients (64% of UC and 58% of CD) had at least one indicator of suboptimal therapy. The median time to suboptimal therapy indicator was 12.5 and 17.5 months for UC and CD patients, respectively. Among the 111 UC and 174 CD anti-TNF switchers, 51% and 56% had an indicator of suboptimal therapy, respectively. The median time to suboptimal therapy indicator with the second anti-TNF was 14.3 and 13.0 months for UC and CD patients, respectively.
The majority of IBD patients showed suboptimal therapy with current anti-TNFs.
有一半的炎症性肠病（IBD）患者对治疗无反应。
评估接受肿瘤坏死因子拮抗剂（抗 TNFs）治疗的 IBD 患者中治疗不充分的发生情况。
在欧洲和加拿大进行了一项多国病历回顾，纳入了 2009 年至 2013 年间诊断为溃疡性结肠炎（UC）或克罗恩病（CD）并开始接受抗 TNF 治疗的 IBD 患者。主要终点是在两年随访期间治疗不充分的累积发生率，定义为存在以下指标：剂量升级、停药、换药、非生物治疗升级或手术。
该研究纳入了 1195 名抗 TNF 初治患者（UC 患者 538 名，CD 患者 657 名）。大多数患者（UC 患者中 64%，CD 患者中 58%）至少有一个治疗不充分的指标。UC 和 CD 患者治疗不充分指标的中位时间分别为 12.5 个月和 17.5 个月。在 111 名 UC 和 174 名 CD 抗 TNF 转换患者中，分别有 51%和 56%有治疗不充分的指标。UC 和 CD 患者使用第二种抗 TNF 药物治疗不充分指标的中位时间分别为 14.3 个月和 13.0 个月。
大多数 IBD 患者使用当前的抗 TNF 药物治疗效果不佳。
