Walsh Jessica A, Song Xue, Kim Gilwan, Park Yujin
University of Utah and Salt Lake City Veteran Affairs Medical Center Division of Rheumatology Salt Lake City UT USA.
Truven Health Analytics, an IBM Company Cambridge MA USA.
J Pharm Health Serv Res. 2018 Jun;9(2):115-121. doi: 10.1111/jphs.12212. Epub 2018 Jan 16.
Comorbidity incidence rates among US patients with ankylosing spondylitis (AS) treated with tumour necrosis factor inhibitors (TNFis) are inadequately understood. This study compared the relative occurrence of comorbidities between patients with AS treated with TNFis and those not treated with TNFis.
Adults aged ≥18 years enrolled in the MarketScan Commercial and Medicare Supplemental databases with a diagnosis of AS between 1 January 2008 and 30 June 2015 were eligible. Patients were divided into two groups, those treated with TNFis (TNFi users) and those not treated with TNFis (TNFi nonusers) during the 12 months after the index date, defined as the date of first TNFi treatment or a randomly assigned date for TNFi nonusers. Patients had to have continuous enrolment for 24 months with no AS diagnosis or TNFi therapy pre-index and a follow-up period of ≥12 months postindex. The incidence of new comorbidities was evaluated in patients and adjusted for baseline characteristics.
A total of 3077 TNFi users and 3830 TNFi nonusers were included. A higher proportion of TNFi users had a new diagnosis of inflammatory bowel disease (hazard ratio [HR], 2.00), including Crohn's disease (HR, 2.45) and ulcerative colitis (HR, 1.65), as well as uveitis (HR, 1.68) and sleep apnoea (HR, 1.21) after initiation of TNFi therapy than TNFi nonusers.
Patients with AS treated with TNFis had higher incidence rates of IBD, uveitis and sleep apnoea after initiation of TNFi therapy than patients not treated with TNFi therapy.
对于美国使用肿瘤坏死因子抑制剂（TNFis）治疗的强直性脊柱炎（AS）患者的合并症发病率，我们了解得并不充分。本研究比较了使用TNFis治疗的AS患者与未使用TNFis治疗的AS患者中合并症的相对发生率。
纳入2008年1月1日至2015年6月30日期间在MarketScan商业和医疗保险补充数据库中登记且年龄≥18岁、诊断为AS的成年人。患者被分为两组，在索引日期（定义为首次使用TNFis治疗的日期或为未使用TNFis治疗的患者随机分配的日期）后的12个月内，使用TNFis治疗的患者（TNFi使用者）和未使用TNFis治疗的患者（TNFi非使用者）。患者必须连续登记24个月，索引前无AS诊断或TNFis治疗，且索引后随访期≥12个月。评估患者中新发合并症的发生率，并根据基线特征进行调整。
共纳入3077名TNFi使用者和3830名TNFi非使用者。与TNFi非使用者相比，TNFi使用者在开始使用TNFi治疗后新诊断为炎症性肠病（风险比[HR]，2.00）的比例更高，包括克罗恩病（HR，2.45）和溃疡性结肠炎（HR，1.65），以及葡萄膜炎（HR，1.68）和睡眠呼吸暂停（HR，1.21）。
与未使用TNFi治疗的患者相比，使用TNFis治疗的AS患者在开始使用TNFi治疗后发生IBD、葡萄膜炎和睡眠呼吸暂停的发生率更高。
