Earlier discontinuation of TNF-α inhibitor therapy in female patients with inflammatory bowel disease is related to a greater risk of side effects

Autor: J Schultheiss, Eelco C. Brand, Willemijn C.M. van den Berg, Fiona D.M. van Schaik, Evert Lamers, Bas Oldenburg, Herma H. Fidder
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
Adolescent
Drug-Related Side Effects and Adverse Reactions
Inflammatory bowel disease
Drug Administration Schedule
Medication Adherence
Arthritis
Rheumatoid
Cohort Studies
03 medical and health sciences
Young Adult
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Adalimumab
Journal Article
Humans
Immunologic Factors
Psoriasis
Pharmacology (medical)
030212 general & internal medicine
Retrospective Studies
Hepatology
business.industry
Tumor Necrosis Factor-alpha
Hazard ratio
Gastroenterology
Antibodies
Monoclonal
Retrospective cohort study
medicine.disease
Inflammatory Bowel Diseases
Golimumab
Discontinuation
Withholding Treatment
Rheumatoid arthritis
Cohort
030211 gastroenterology & hepatology
Female
Immunotherapy
business
medicine.drug
Zdroj: Alimentary Pharmacology & Therapeutics, 50(4), 386. Wiley-Blackwell
ISSN: 1365-2036
0269-2813
Popis: Background In rheumatoid arthritis and psoriasis female sex has been shown to be associated with discontinuation of anti-tumour necrosis factor-α (TNF-α) therapy. Aim To retrospectively assess the association between sex and TNF-α drug persistence in patients with inflammatory bowel disease (IBD). Methods All IBD patients on anti-TNF-α therapy with a minimum follow-up of 12 months in a single tertiary centre were identified. Patient and treatment characteristics and reasons for anti-TNF-α discontinuation were recorded. Overall and cause-specific drug persistence was analysed with Kaplan-Meier followed by Cox proportional hazards regression models. Results We included 529 patients (49.9% male) with 631 treatment episodes (2280 anti-TNF-α treatment years) and 289 discontinuations of therapy. Female sex (adjusted hazard ratio [aHR] 1.42, 95% confidence interval [CI] 1.16-1.74), greater age at start of therapy per decade (aHR 1.15, 95% CI 1.04-1.27] and dose escalation (aHR 3.74, 95% CI 2.78-5.02) were associated with TNF-α inhibitor discontinuation. Total cohort cause-specific analysis identified female sex to be associated with side effects (aHR 4.05, 95% CI 2.36-6.98) but not to other discontinuation reasons. Adalimumab (aHR 1.70, 95% CI 1.11-2.60) and golimumab (aHR 4.97, 95% CI 2.30-10.74) use and dose-escalation (aHR 7.71, 95% CI 5.28-11.26) were associated with secondary loss of response. Conclusion Drug persistence of anti-TNF-α therapy is lower in females as compared to males, mainly because of higher rates of side effects in females. Understanding the sex specific differences in effectiveness and safety of anti-TNF-α compounds can aid physicians in clinical decision-making.
Databáze: OpenAIRE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje