Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
Division of Hematology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
J Natl Med Assoc. 2019 Jun;111(3):262-269. doi: 10.1016/j.jnma.2018.10.003. Epub 2018 Oct 30.
The aim of this study was to determine whether there is any association with anti-tumor necrosis factor (TNF) agent administration and development of new-onset inflammatory bowel disease (IBD) in ankylosing spondylitis (AS) patients.
Records of the patients who met 1984 modified New York criteria for AS between 1998 and 2016 at Rheumatology Department were evaluated retrospectively and data about the patients, IBD properties and medication were obtained.
Among 420 patients, 310 were male, the average age was 42.9 ± 1.3 years, average disease duration was 16.7 ± 10.4 years. Anti-TNF agents were in use by 154 patients, 52 patients were receiving etanercept (ETN), infliximab (INF), adalimumab (ADA), and golimumab (GO) treatments were ongoing in 50, 41, and 11 patients, respectively. New-onset IBD developed in 10 patients; 3 from the group treated with non-anti-TNF drugs (1.1%) and 7 from the group treated with anti-TNF agents (4.5%) (p = 0.042). No significant difference was detected between three anti-TNF agent forms in relation with the risk of IBD onset. In AS patients, existence of familial AS (OR 4.69 (95%CI 1.28-17.19, p = 0.020) and anti-TNF agent treatment (OR 4.17 (95%CI 1.06-16.38, p = 0.041) were independent risk factors for new-onset IBD development.
Despite the increased risk of new-onset IBD development during the course of AS, paradoxical response to anti-TNF drugs must also be considered as a source that triggers onset of IBD.
本研究旨在确定肿瘤坏死因子（TNF）拮抗剂治疗与强直性脊柱炎（AS）患者新发生炎症性肠病（IBD）之间是否存在关联。
回顾性评估了 1998 年至 2016 年风湿科符合 1984 年改良纽约标准的 AS 患者的病历，获取了患者、IBD 特征和药物使用情况的数据。
在 420 例患者中，310 例为男性，平均年龄为 42.9±1.3 岁，平均病程为 16.7±10.4 年。154 例患者使用了抗 TNF 药物，52 例患者接受依那西普（ETN）治疗，50、41 和 11 例患者正在接受英夫利昔单抗（INF）、阿达木单抗（ADA）和戈利木单抗（GO）治疗。10 例患者新发生 IBD，3 例来自非抗 TNF 药物治疗组（1.1%），7 例来自抗 TNF 药物治疗组（4.5%）（p=0.042）。三种抗 TNF 药物形式在 IBD 发病风险方面无显著差异。在 AS 患者中，家族性 AS（OR 4.69（95%CI 1.28-17.19，p=0.020）和抗 TNF 药物治疗（OR 4.17（95%CI 1.06-16.38，p=0.041）是新发生 IBD 的独立危险因素。
尽管 AS 患者发生新的 IBD 风险增加，但也必须考虑抗 TNF 药物的矛盾反应是触发 IBD 发生的一个来源。
