Association of Antibiotic Use with Durability of Biologic Agents in Inflammatory Bowel Disease: a Report from the epi-IIRN.

Autor: Gorelik Y; Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel., Ghersin I; Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel., Shlon D; Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel., Friss C; Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Israel., Lujan R; Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Israel., Loewenberg Weisband Y; Clalit Health Services, Clalit Research Institute, Tel-Aviv, Israel., Greenfeld S; Maccabi Health Services, Tel-Aviv, Israel.; The Sackler Faculty of Medicine, Tel Aviv University, Israel., Kariv R; Maccabi Health Services, Tel-Aviv, Israel.; The Sackler Faculty of Medicine, Tel Aviv University, Israel., Ledderman N; Meuhedet Health Services, Meuhedet Research Institue, Tel-Aviv, Israel., Matz E; Leumit Health Services, Leumit Research Institue, Tel-Aviv, Israel., Dotan I; Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel., Bar-Yoseph H; Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel., Chowers Y; Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.; Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel., Turner D; Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Israel.
Jazyk: angličtina
Zdroj: Journal of Crohn's & colitis [J Crohns Colitis] 2023 Oct 20; Vol. 17 (9), pp. 1410-1417.
DOI: 10.1093/ecco-jcc/jjad070
Abstrakt: Background: Different antibiotic classes were reported to have variable effects on immunogenicity towards anti-tumour necrosis factor [TNF] agents. However, the impact of antibiotic administration on biologic treatment durability was not investigated. We aimed to assess the association between antibiotic treatment and persistence of different classes of biologic therapy in inflammatory bowel disease [IBD] patients.
Methods: Data from the epi-IIRN, a nationwide registry of all Israeli IBD patients were analysed. All patients who filled a prescription of either infliximab, adalimumab, vedolizumab, or ustekinumab, were included. Treatment cessation was defined as drug discontinuation of at least 6 months. Macrolides, cephalosporins, fluoroquinolones, and penicillins with beta-lactamase inhibitors were selected as primary exposure variables. Survival analysis was performed using marginal structural models for each drug separately.
Results: In all 13 513 IBD patients, with a total of 39 600 patient-years, were included. Significant differences of overall treatment persistence were demonstrated, with highest persistence rates for ustekinumab and the lowest for infliximab treatment. Macrolides were found to be significantly associated with reduced risk of infliximab cessation (adjusted hazard ratio [aHR] 0.72, 95% CI 0.62-0.89]. Fluoroquinolones and cephalosporins were associated with an elevated risk of adalimumab treatment cessation [aHR 1.33, 95% CI 1.22-1.46; and aHR 1.20, 95% CI 1.08-1.34, respectively]. No significant effects of the studied antibiotics were observed in ustekinumab and vedolizumab users.
Conclusions: Specific antibiotic classes are associated with duration of anti-TNF treatment, but not with durability of vedolizumab or ustekinumab treatments. Further research is required to study the effect of specific antibiotics on response to biologics.
(© The Author(s) 2023. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze: MEDLINE
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