Laganà Bruno, Zullo Angelo, Scribano Maria Lia, Chimenti Maria Sole, Migliore Alberto, Picchianti Diamanti Andrea, Lorenzetti Roberto, Scolieri Palma, Ridola Lorenzo, Ortona Elena, Pierdominici Marina, Bruzzese Vincenzo
Autoimmune Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
Front Pharmacol. 2019 Jan 28;10:47. doi: 10.3389/fphar.2019.00047. eCollection 2019.
Spondyloarthritis (SpA) and inflammatory bowel diseases (IBD) are chronic inflammatory diseases characterized by an aberrant immune response and inflammation with a key role for TNF in their pathogenesis. Accordingly, TNF-inhibiting therapy (TNFi) has dramatically improved the management of these diseases. However, about 30% of patients discontinue TNFi for lack of response, loss of response, and side effects and/or adverse events. Thus, the possibility to identify in advance those patients who will have a good response to TNFi would be extremely beneficial. The aim of this study was to investigate differences between males and females with either SpA or IBD in response to TNFi molecules, i.e., infliximab (IFX) and adalimumab (ADA), considering the reasons for TNFi withdraw. Data of 594 patients, 349 with IBD (M/F: 194/155) and 245 with SpA (M/F: 123/122), previously unexposed to TNFi, were collected. In the IBD group, the rate of female patients discontinuing ADA was significantly higher than that of male patients ( = 0.03). No difference emerged according to the distribution of reason for discontinuation. Otherwise, a similar discontinuation rate between female and male patients receiving IFX therapy was observed. In the SpA group, the overall discontinuation rate was not different between males and females both for ADA and IFX. However, in patients treated with ADA, males interrupted therapy more frequently than females due to lack of response ( = 0.03). In conclusion, the assessment of sex differences in TNFi response could help physicians personalize the therapeutic approach in a sex-oriented perspective.
脊柱关节炎（SpA）和炎症性肠病（IBD）是慢性炎症性疾病，其特征为异常免疫反应和炎症，肿瘤坏死因子（TNF）在其发病机制中起关键作用。因此，TNF抑制疗法（TNFi）显著改善了这些疾病的治疗。然而，约30%的患者因无反应、反应丧失以及副作用和/或不良事件而停用TNFi。因此，提前识别那些对TNFi将有良好反应的患者将极为有益。本研究的目的是调查患有SpA或IBD的男性和女性在对TNFi分子（即英夫利昔单抗（IFX）和阿达木单抗（ADA））的反应方面的差异，并考虑停用TNFi的原因。收集了594例先前未接触过TNFi的患者的数据，其中349例患有IBD（男/女：194/155），245例患有SpA（男/女：123/122）。在IBD组中，停用ADA的女性患者比例显著高于男性患者（P = 0.03）。根据停药原因分布未发现差异。否则，观察到接受IFX治疗的女性和男性患者的停药率相似。在SpA组中，ADA和IFX治疗的男性和女性总体停药率没有差异。然而，在接受ADA治疗的患者中，男性因无反应而比女性更频繁地中断治疗（P = 0.）。总之，评估TNFi反应中的性别差异有助于医生从性别导向的角度个性化治疗方法。 （注：原文中“(P = 0.)”表述有误，可能影响理解，翻译时保留原文错误）
