Section of Gastroenterology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
Inflamm Bowel Dis. 2020 Jan 1;26(1):150-157. doi: 10.1093/ibd/izz148.
Few data exist about the utilization of combination therapy (anti-tumor necrosis factor [anti-TNF] plus immunosuppressives) in clinical practice. We assessed the prevalence and predictors of combination therapy use vs anti-TNF monotherapy in inflammatory bowel disease (IBD) in the Canadian province of Manitoba.
All 23 prescribers of anti-TNF medications for IBD in Manitoba facilitated chart review of their comprehensive lists of adult anti-TNF patients from 2005 to 2015. Subjects were stratified by year of first anti-TNF exposure. Patient, disease, and prescriber factors influencing combination therapy use were explored.
A total of 774 patients met inclusion criteria. Seventy-one point one percent had Crohn's disease (CD), 28.3% had ulcerative colitis (UC), and 0.6% had IBD unclassified; 45.3% received combination therapy, with no difference between CD and UC. Crohn's disease subjects receiving combination therapy were more likely to have penetrating or perianal disease (56.9% vs 42.8%; P = 0.001) and less likely to have had previous IBD-related surgeries (36.2% vs 46.2%; P = 0.02). The median age at diagnosis and at anti-TNF initiation was lower among combination therapy users. Adalimumab users were as likely as infliximab users to receive combination therapy but persisted with treatment for a shorter time. The proportion of new anti-TNF users receiving combination therapy did not change over time (P = 0.43). There was substantial variation in combination therapy use between prescribers (P = 0.002). The most frequently encountered reasons for avoiding combination therapy were previous intolerance or ineffectiveness of immunosuppressive monotherapy.
Use of combination therapy has remained unchanged over time despite the publication of high-quality data supporting its efficacy over anti-TNF monotherapy.
关于联合治疗（抗肿瘤坏死因子 [anti-TNF] 加免疫抑制剂）在临床实践中的应用，数据有限。我们评估了在加拿大马尼托巴省炎症性肠病（IBD）中，联合治疗与抗 TNF 单药治疗的使用情况和预测因素。
马尼托巴省的 23 名抗 TNF 药物的开具者为其 2005 年至 2015 年所有成年抗 TNF 患者的综合名单进行了图表审查。根据首次抗 TNF 暴露的年份对患者进行分层。探讨了影响联合治疗使用的患者、疾病和开具者因素。
共有 774 名患者符合纳入标准。71.1%患有克罗恩病（CD），28.3%患有溃疡性结肠炎（UC），0.6%患有未分类的 IBD；45.3%接受了联合治疗，CD 和 UC 之间没有差异。接受联合治疗的 CD 患者更有可能患有穿透性或肛周疾病（56.9% vs. 42.8%；P=0.001）和较少有以前的 IBD 相关手术（36.2% vs. 46.2%；P=0.02）。联合治疗使用者的诊断和抗 TNF 起始年龄中位数较低。阿达木单抗使用者与英夫利昔单抗使用者一样，有可能接受联合治疗，但治疗时间较短。接受新的抗 TNF 治疗的患者接受联合治疗的比例并未随时间而改变（P=0.43）。不同开具者之间的联合治疗使用率存在很大差异（P=0.002）。避免联合治疗的最常见原因是以前对免疫抑制剂单药治疗不耐受或无效。
尽管有高质量的数据支持抗 TNF 联合治疗优于单药治疗，但联合治疗的使用在过去一段时间内并没有改变。
