大陆分水岭：与世界其他地区相比，TNF 拮抗剂在北美的儿科 IBD 中的应用有所不同。
The Continental Divide: Anti-TNF Use in Pediatric IBD Is Different in North America Compared to Other Parts of the World.
机构信息
Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Canada.
Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT, USA.
出版信息
Can J Gastroenterol Hepatol. 2018 Jun 12;2018:3190548. doi: 10.1155/2018/3190548. eCollection 2018.
BACKGROUND AND AIMS
Use of anti-TNF therapies varies internationally. As an initiative of the international Pediatric IBD Network (PIBDNet), we compared global pediatric IBD anti-TNF practice patterns.
METHODS
Physicians were surveyed about anti-TNF use in Crohn's disease (CD) and ulcerative colitis (UC). Chi-squared, independent samples Mann-Whitney , or related samples Wilcoxon signed rank tests were used to compare groups.
RESULTS
344 physicians treating pediatric IBD responded from 43 countries (54% North America, 29% Europe, 6% Oceania, 6% Asia, 3% Africa, and 2% South America). Respondents treated a median 40 IBD patients. CD was more commonly treated with anti-TNF than UC (40% vs. 10%, p<0.001). North Americans more often used anti-TNF (median 50% vs. 30%, p<0.001) and before immunomodulator (80% vs. 35% CD, p<0.001; 76% vs. 43% steroid-dependent UC, p<0.001). Anti-TNF monotherapy was more common in North America. Anti-TNF in combination with methotrexate, instead of thiopurine, characterized North American practices. North Americans more often continued immunomodulator indefinitely and less often adhered to standard infliximab induction dosing. Access limitations were more common outside North America and Europe for both CD (67% vs. 31%, p<0.001) and UC (62% vs. 33%, p<0.001).
CONCLUSIONS
Anti-TNF use in North America varies significantly from elsewhere.
背景与目的
抗 TNF 治疗在国际上的应用存在差异。作为国际儿科 IBD 网络（PIBDNet）的一项倡议，我们比较了全球儿科 IBD 抗 TNF 治疗模式。
方法
对治疗儿童 IBD 的医生进行了关于克罗恩病（CD）和溃疡性结肠炎（UC）使用抗 TNF 治疗的调查。使用卡方检验、独立样本 Mann-Whitney U 检验或相关样本 Wilcoxon 符号秩检验比较组间差异。
结果
来自 43 个国家的 344 名治疗儿科 IBD 的医生（北美 54%、欧洲 29%、大洋洲 6%、亚洲 6%、非洲 3%、南美洲 2%）对问卷做出了回应。受访者平均治疗 40 例 IBD 患者。CD 使用抗 TNF 治疗的比例高于 UC（40% vs. 10%，p<0.001）。北美更常使用抗 TNF（中位数 50% vs. 30%，p<0.001），且在使用免疫调节剂之前（80% vs. 35% CD，p<0.001；76% vs. 43% 依赖激素 UC，p<0.001）。北美更常使用抗 TNF 单药治疗。北美更常使用抗 TNF 联合甲氨蝶呤而非硫唑嘌呤。北美更常无限期使用免疫调节剂，较少遵循标准英夫利昔单抗诱导剂量。CD（67% vs. 31%，p<0.001）和 UC（62% vs. 33%，p<0.001）在北美和欧洲以外地区获得抗 TNF 治疗的限制更为常见。
结论
北美的抗 TNF 治疗应用与其他地区存在显著差异。
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