IBD:炎症性肠病抗TNF治疗前后严重感染的风险:一项回顾性队列研究

2022-08-10 消化界 IBD Daily

黏膜的愈合可能超过了对感染风险的不良免疫抑制作用,并强调了治疗基础疾病的重要性。这些发现适用于与病人一起评估疗法的风险和益处。

The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study

Inflammatory bowel diseases

PMID: 35776552  [IF=7.29]

炎症性肠病 (IBD) 包括克罗恩病 (CD)、溃疡性结肠炎 (UC) 和未分类的炎症性肠病 (IBD-U),是一种影响胃肠道的慢性炎症性疾病。抗肿瘤坏死因子 (TNF) 治疗已经成为常规治疗失败的IBD患者的中重度发作和维持缓解的标准治疗方法。早期对使用抗TNF相关的感染风险的研究显示了不同的结果,随机对照试验和观察性研究的数据是相互矛盾的。在使用抗TNF的IBD患者中观察到了严重的感染,但这些感染在多大程度上是由抗TNF或疾病活动本身引起的很难区分。

本研究的目的是描述在活动期的IBD抗TNF治疗启动前后严重感染率的变化,从而阐明抗TNF (相对于疾病活动) 对感染风险的作用。进行了一项队列研究,比较了抗TNF启动前后的严重感染发生率。

在瑞典的5个IBD中心确定了未接受抗TNF治疗的IBD患者,并详细检查了他们的医疗记录。评估了抗TNF治疗开始前后一年的严重感染 (严重感染被定义为需要住院治疗的感染)。

图1:在抗TNF治疗开始前一年和抗TNF治疗期间,IBD患者严重感染的年发病率。

图源:参考文献 [1]

在1999年至2016年间首次开始抗TNF治疗的980名患者中,肺炎是抗TNF治疗前最常见的严重感染,其次是胃肠炎和败血症。严重感染的发生率在治疗开始前一年为每100人年2.19 (95% CI 1.43-3.36),在治疗开始后一年为每100人年2.11 (95% CI 1.33-3.34)。从开始抗 TNF 治疗到首次严重感染的中位时间为 1.9 年 (IQR1-IQR3, 0.8-4.4)。与抗TNF治疗前一年相比,治疗后第一年严重感染的发生率没有变化 (发生率比0.97;95% CI 0.51-1.84, P = 0.915)。而在抗TNF治疗1年后,严重感染的发生率明显下降 (发生率比0.56;95%CI 0.33-0.95, P = 0.03)。

在这项来自瑞典5个IBD中心的真实世界研究中,IBD患者的严重感染率在开始抗TNF治疗的前一年和后一年同样高,而在抗TNF治疗的第一年后则显著降低。黏膜的愈合可能超过了对感染风险的不良免疫抑制作用,并强调了治疗基础疾病的重要性。这些发现适用于与病人一起评估疗法的风险和益处。

参考文献

1. Holmgren J, Fröborg A, Visuri I, et al. The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study [published online ahead of print, 2022 Jul 1]. Inflamm Bowel Dis. 2022;izac097. doi:10.1093/ibd/izac097

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    2023-02-01 mfx808
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    2022-08-12 bnurmamat
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    2022-08-12 snowpeakxu
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