Lenti Marco Vincenzo, Santacroce Giovanni, Lepore Federica, Mordà Francesco, Lo Bello Antonio, Aronico Nicola, Mengoli Caterina, Delliponti Mariangela, Frondana Raphael, Frondana Iara Moreira, Di Sabatino Antonio
Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy.
First Department of Internal Medicine, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Università Di Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
Intern Emerg Med. 2025 Apr 25. doi: 10.1007/s11739-025-03943-1.
Factors driving the persistence of advanced therapies-defined as the duration from therapy initiation to discontinuation-in inflammatory bowel disease (IBD) remain unclear. This study aimed to evaluate the persistence of biologics and oral small molecules in a real-word IBD cohort and to identify influencing factors. Data from IBD patients starting advanced therapy at a tertiary referral centre after 2010 were retrospectively collected, including persistence and discontinuation reasons. Differences in persistence probability among therapies were analysed, and factors influencing persistence versus discontinuation due to failure were assessed by univariate and multivariate analyses. Among 274 included patients [median age 42.5 years; F/M 119/155; 146 with Crohn's disease (CD) and 128 with ulcerative colitis; median follow-up 38 months (IQR 14-75)], 141 (51.5%) remained persistent with first-line therapy, while 70 (26%) discontinued due to failure. No significant difference in persistence was observed among drugs (p = 0.11). Univariate analysis identified CD phenotype (p < 0.01), disease duration prior to therapy (p = 0.01), concomitant mesalamine or steroids (p < 0.01), and therapy optimisation (p < 0.01) as factors influencing persistence. Multivariate analysis confirmed CD phenotype as associated with higher persistence, while therapy optimisation was linked to increased discontinuation risk. CD was associated with better drug persistence, while therapy optimisation correlated with a higher discontinuation rate. Targeting deep healing and enhancing timely, precise optimisation strategies is essential for improving treatment outcomes.
在炎症性肠病（IBD）中，推动先进疗法持续使用的因素（定义为从开始治疗到停药的持续时间）仍不明确。本研究旨在评估真实世界IBD队列中生物制剂和口服小分子药物的持续使用情况，并确定影响因素。回顾性收集了2010年后在三级转诊中心开始接受先进疗法的IBD患者的数据，包括持续使用情况和停药原因。分析了不同疗法之间持续使用概率的差异，并通过单因素和多因素分析评估了影响因治疗失败而持续使用或停药的因素。在纳入的274例患者中[中位年龄42.5岁；女性/男性119/155；146例克罗恩病（CD）患者和128例溃疡性结肠炎患者；中位随访38个月（四分位间距14 - 75）]，141例（51.5%）一线治疗持续有效，而70例（26%）因治疗失败而停药。各药物之间的持续使用情况无显著差异（p = 0.11）。单因素分析确定CD表型（p < 0.01）、治疗前疾病持续时间（p = 0.01）、同时使用美沙拉嗪或类固醇（p < 0.01）以及治疗优化（p < 0.01）为影响持续使用的因素。多因素分析证实CD表型与更高的持续使用率相关，而治疗优化与停药风险增加有关。CD与更好的药物持续使用相关，而治疗优化与更高的停药率相关。针对深度愈合并加强及时、精确的优化策略对于改善治疗结果至关重要。
