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 |
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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 |
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