抗瘤坏死因子治疗和功能下降和炎症性肠病死亡率的风险
Keiichi Sumida1, Prabin Shrestha1, Yamini Mallisetty1
1Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis.
JAMA network open
|April 16, 2024
概括
在新发炎性肠病 (IBD) 患者中使用抗瘤缩因子 (TNF) 抑制剂与较高的功能下降风险有关. 然而,这种疗法并没有增加这个患者群体因任何原因死亡的风险.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
背景情况:
- 炎症性肠病 (IBD) 与慢性病和死亡率等不良结果有关,部分原因是慢性炎症.
- 抗瘤坏死因子 (TNF) 治疗对新发IBD患者病进展和死亡率的影响尚不清楚.
研究的目的:
- 调查TNF抑制剂的初始使用与随后的功能下降和新发IBD患者全因死亡率之间的关联.
主要方法:
- 一项回顾性队列研究利用了美国退伍军人事务部对2004-2019年新发IBD的退伍军人卫生系统的数据.
- 发生性使用TNF抑制剂是主要暴露,估计膜过率 (eGFR) 和全因死亡率下降30%作为主要结果.
- 分析了从2022年12月到2024年2月的数据,并对混因素进行了多变量调整.
主要成果:
- 在10689名新发IBD患者中,15.2%的人开始抗TNF治疗. 在随访期间,31.4%的人经历了30%的eGFR下降,23.4%的人死亡.
- 发生的抗TNF疗法使用与逐渐降低eGFR的风险增加显著相关 (aHR,1.34;95% CI,1.18-1.52).
- 在偶尔使用抗TNF治疗和全因死亡风险之间没有发现显著的关联 (aHR,1.02;95% CI,0.86-1.21).
结论:
- 在患有新发IBD的美国退伍军人中,开始抗TNF疗法与逐渐下降的功能风险更高独立相关.
- 在这个队列中,开始抗TNF治疗与全因死亡风险的增加无关.
- 需要进一步的研究,以了解特定的病理生理机制,将TNF抑制剂使用与IBD患者的脏和非脏结果联系起来.
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