炎症性肠病患儿肿瘤坏死因子拮抗剂的利用趋势：一项加拿大基于人群的研究。

Trends of Utilization of Tumor Necrosis Factor Antagonists in Children With Inflammatory Bowel Disease: A Canadian Population-Based Study.

机构信息

Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.

University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.

出版信息

Inflamm Bowel Dis. 2020 Jan 1;26(1):134-138. doi: 10.1093/ibd/izz157.

DOI:10.1093/ibd/izz157

PMID:31323083

Abstract

BACKGROUND

Population-based studies examining the prevalence of anti-tumor necrosis factor (anti-TNF) antagonist utilization in children and young adults with inflammatory bowel disease (IBD) are lacking. We aimed to describe the trend of anti-TNF utilization in pediatric IBD over time.

METHODS

Survival analyses were performed for all patients diagnosed with IBD before age 18 years in the province of Manitoba to determine the time from diagnosis to first anti-TNF prescription in different time eras (2005-2008, 2008-2012, 2012-2016).

RESULTS

There were 291 persons diagnosed with IBD (157 with Crohn's disease [CD] and 134 with ulcerative colitis [UC]) over the study period. The likelihood of being initiated on an anti-TNF by 1, 2, and 5 years postdiagnosis was 18.4%, 30.5%, and 42.6%, respectively. The proportion of persons aged <18 years utilizing anti-TNFs rose over time; in 2010, 13.0% of CD and 4.9% of UC; by 2016, 60.0% of CD and 25.5% of UC. For those diagnosed after 2012, 42.5% of CD and 28.4% of UC patients had been prescribed an anti-TNF antagonist within 12 months of IBD diagnosis. Initiating an anti-TNF without prior exposure to an immunosuppressive agent increased over time (before 2008: 0%; 2008-2012: 18.2%; 2012-2016: 42.8%; P < 0.001). There was a significant reduction in median cumulative dose of corticosteroids (CS) in the year before anti-TNF initiation (2005-2008: 4360 mg; 2008-2012: 2010 mg; 2012-2016: 1395 mg prednisone equivalents; P < 0.001).

CONCLUSIONS

Over a period of 11 years, anti-TNFs are being used earlier in the course of pediatric IBD, with a parallel reduction in the cumulative CS dose.

摘要

背景

缺乏基于人群的研究来评估在儿童和青年炎症性肠病（IBD）患者中抗肿瘤坏死因子（anti-TNF）拮抗剂的使用情况。本研究旨在描述儿科 IBD 中抗 TNF 的使用趋势随时间的变化。

方法

对在曼尼托巴省 18 岁之前被诊断为 IBD 的所有患者进行生存分析，以确定在不同时间（2005-2008 年、2008-2012 年、2012-2016 年）从诊断到首次使用抗 TNF 的时间。

结果

研究期间共诊断出 291 名 IBD 患者（157 名克罗恩病 [CD] 和 134 名溃疡性结肠炎 [UC]）。诊断后 1、2 和 5 年开始使用抗 TNF 的可能性分别为 18.4%、30.5%和 42.6%。在接受抗 TNF 治疗的人群中，年龄<18 岁的比例随时间增加；2010 年，CD 为 13.0%，UC 为 4.9%；到 2016 年，CD 为 60.0%，UC 为 25.5%。对于那些在 2012 年后被诊断为 IBD 的患者，42.5%的 CD 和 28.4%的 UC 患者在 IBD 诊断后 12 个月内被处方了抗 TNF 拮抗剂。在没有预先使用免疫抑制剂的情况下开始使用抗 TNF 的比例随时间增加（2008 年之前：0%；2008-2012 年：18.2%；2012-2016 年：42.8%；P<0.001）。在抗 TNF 治疗前一年，皮质类固醇（CS）的累积剂量中位数显著降低（2005-2008 年：4360mg；2008-2012 年：2010mg；2012-2016 年：1395mg 泼尼松等效剂量；P<0.001）。