Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA.
Department of Dermatology, University of Michigan, Ann Arbor, MI, USA.
Dig Dis Sci. 2023 Oct;68(10):4001-4008. doi: 10.1007/s10620-023-08062-5. Epub 2023 Aug 9.
Patients with inflammatory bowel disease (IBD) are at increased risk for many co-morbid diseases. However, little is known about durability of IBD medications in patients with co-morbid diseases.
Determine medication durability in IBD patients with and without psoriasis, rheumatoid arthritis, and/or enteropathic arthropathy.
All patients with at least three ICD-9 or 10 diagnoses for IBD were included in the cohort. The risk factors of interest were a co-morbid diagnosis of psoriasis (IBD-Ps), rheumatoid arthritis (IBD-RA), and/or enteropathic arthritis (IBD-EA). Medication durability was defined as days of medication use, calculated using order start and stop dates from the electronic medical record. Significant differences were tested using the Wilcoxon rank sum test for continuous variables and Fisher's exact test or Pearson's Chi-squared test, as appropriate, for categorical variables. Boxplots were constructed for graphical interpretation of results.
In the psoriasis group, there were 481 patients with 831 medication exposures [131 IBS-Ps (16%), 700 IBD only (84%)]. The median days of medication use were numerically higher in the IBD-Ps group for all therapies [anti-TNF: 1109 vs 861 (p = 0.17); anti-IL-12/23: 984 vs 834 (p = 0.33); JAKi: 682 vs 230 (p = 0.13)], anti-TNF/IM: 370 vs 202 (p = 0.57), except anti-integrin therapy [214 vs 470 (p = 0.08)]. When restricting to UC only, patients with co-morbid again Ps had a significantly shorter duration on anti-integrin therapy (84 vs 456 days, p = 0.02). While not reaching statistical significance, there was a distinctly longer medication duration on JAKi therapy (910 vs 317, p = 0.10). When restricting to patients with CD only, no results reached statistical significance though there was a trend towards longer anti-TNF durability in CD-Ps (1340 vs 1000 days, p = 0.098). There were no differences in medication durability in IBD-RA or IBD-EA patients.
Larger studies investigating medication durability of JAKi and anti-integrin therapy in IBD patients with psoriasis would be beneficial given noteworthy trends towards increased and decreased durability, respectively.
炎症性肠病（IBD）患者发生多种合并症的风险增加。然而，对于合并症患者中 IBD 药物的耐久性知之甚少。
确定合并银屑病、类风湿关节炎和/或肠病性关节炎的 IBD 患者中药物的耐久性。
所有至少有 3 次 IBD 的 ICD-9 或 10 诊断的患者均纳入该队列。感兴趣的风险因素是合并银屑病（IBD-Ps）、类风湿关节炎（IBD-RA）和/或肠病性关节炎（IBD-EA）的诊断。药物耐久性定义为使用药物的天数，使用电子病历中的订单开始和停止日期计算。使用 Wilcoxon 秩和检验比较连续变量的差异，使用 Fisher 确切检验或 Pearson 卡方检验（视情况而定）比较分类变量的差异。使用箱线图进行结果的图形解释。
在银屑病组中，有 481 例患者有 831 次药物暴露[131 例 IBS-Ps（16%），700 例 IBD 患者（84%）]。在所有治疗中，IBD-Ps 组的药物使用天数均较高[抗 TNF：1109 与 861（p=0.17）；抗 IL-12/23：984 与 834（p=0.33）；JAKi：682 与 230（p=0.13）]，抗 TNF/IM：370 与 202（p=0.57），除了抗整合素治疗[214 与 470（p=0.08）]。当仅限制为 UC 时，合并再次银屑病的患者抗整合素治疗的持续时间明显缩短（84 与 456 天，p=0.02）。虽然未达到统计学意义，但 JAKi 治疗的药物持续时间明显延长（910 与 317 天，p=0.10）。当仅限制为 CD 患者时，尽管有延长 CD-Ps 抗 TNF 持续时间的趋势（1340 与 1000 天，p=0.098），但没有结果达到统计学意义。在 IBD-RA 或 IBD-EA 患者中，药物耐久性没有差异。
鉴于抗 JAKi 和抗整合素治疗在合并银屑病的 IBD 患者中药物耐久性分别有显著增加和减少的趋势，因此进行更大规模的研究以调查 JAKi 和抗整合素治疗的药物耐久性将是有益的。
