Clin Gastroenterology H: 在老年炎症性肠病患者中,维多珠单抗导致的严重感染风险低于抗 TNF-α 药物

2021-09-14 MedSci原创 MedSci原创

尽管患有炎症性肠病 (IBD) 的老年人数量不断增加,但关于老年人 IBD 治疗的安全性和有效性的研究很少。

老年人炎症性肠病(senile inflammatory bowel disease,IBD)一般指炎症性肠病患者发病时的年龄大于60或65岁,此外,还指一部分老年人炎症性肠病患者是在年轻时发病,病程延续到60或65岁以上。由于老年人所处的特殊年龄阶段,肠病的病因,鉴别诊断以及处理比年轻人会更复杂,因此其临床治疗也比较棘手。尽管患有炎症性肠病 (IBD) 的老年人数量不断增加,但关于老年人 IBD 治疗的安全性和有效性的研究很少。本项研究旨在比较抗肿瘤坏死因子 (TNF)-α药物和维多珠单抗在患有 IBD 的老年人中的安全性和有效性的差异。

 

研究人员针对 65 岁以上患有 IBD 且启动抗 TNF-α 药物和维多珠单抗治疗的成年人进行了一项回顾性队列研究。主要观察结局是感染相关的住院治疗情况(不包括腹内和肛周脓肿)。评估有效性的主要结果是 IBD 相关住院、IBD 相关手术和生物制剂开始后 60 天以上皮质类固醇的使用情况。最后使用标准化发病率 (SMR) 加权变量进行倾向评分加权以控制混杂和估计的调整风险比 (aHR) 和 95% 置信区间 (CI)。

总共有1152 名使用抗 TNF-α治疗的患者和 480 名使用维多珠单抗治疗的患者。两个队列的中位年龄均为 71 岁,年龄≥80 岁占11% 。克罗恩病患者占抗 TNF-α 队列的 54% ,占维多珠单抗队列的 57%。两个队列在人口统计学、医疗保健利用方面没有显着差异,研究结果显示维多珠单抗使用者的感染相关住院风险降低(aHR:0.47,95% CI:0.25 – 0.86),而抗 TNF-α治疗的患者的相关感染风险则未明显降低。

本项研究证实与开始抗肿瘤坏死因子治疗的患者相比,接受维多珠单抗治疗的老年 IBD 患者感染相关住院的风险较低。

原始出处:

Bharati Kochar. Et al. Vedolizumab is associated with a lower risk of serious infections than anti-TNF agents in older adults. Clinical Gastroenterology and Hepatology.2021.

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    2022-06-28 许安
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    2021-09-16 snowpeakxu
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