在生物制剂时代，炎症性肠病的治疗策略发生了变化：来自日本远东地区1000个多中心队列的结果
Treatment strategy changes for inflammatory bowel diseases in biologic era: results from a multicenter cohort in Japan, Far East 1000.
发表日期：2023 Aug 21
作者：
Takashi Taida, Yuki Ohta, Jun Kato, Sadahisa Ogasawara, Yuhei Ohyama, Yukiyo Mamiya, Hayato Nakazawa, Ryosuke Horio, Chihiro Goto, Satsuki Takahashi, Akane Kurosugi, Michiko Sonoda, Wataru Shiratori, Tatsuya Kaneko, Yuya Yokoyama, Naoki Akizue, Yotaro Iino, Junichiro Kumagai, Hideaki Ishigami, Hirotaka Koseki, Kenichiro Okimoto, Keiko Saito, Masaya Saito, Tomoaki Matsumura, Tomoo Nakagawa, Shinichiro Okabe, Hirofumi Saito, Kazuki Kato, Hirotsugu Uehara, Hideaki Mizumoto, Yoshihiro Koma, Ryosaku Azemoto, Kenji Ito, Hidehiro Kamezaki, Yoshifumi Mandai, Yoshio Masuya, Yoshihiro Fukuda, Yoshio Kitsukawa, Haruhisa Shimura, Toshio Tsuyuguchi, Naoya Kato
来源：
MOLECULAR & CELLULAR PROTEOMICS
摘要：
临床治疗炎症性肠病时，许多靶向分子药物，包括生物制剂，已经出现，但其高昂的价格限制了其广泛应用。本研究旨在揭示日本生物制剂实施前后炎症性肠病患者特征和治疗策略的变化，日本独特的医疗保险体系允许炎症性肠病患者和医生选择患者费用最低的药物。本研究采用前瞻性队列研究，包括日本炎症性肠病专家和非专家医院。本研究根据英夫利昔单抗实施的年份将患者分为两组，作为生物制剂实施前和生物制剂时代组。使用关联分析评估了两组治疗策略的特征。本研究分析了542例溃疡性结肠炎（UC）和186例克罗恩病（CD）。生物制剂时代组中UC患者的比例为53.3％，CD患者的比例为76.2％。生物制剂时代组的UC诊断年龄（33.9岁vs. 38.8岁，P＜0.001）和CD诊断年龄（24.3岁vs. 31.9岁，P＜0.001）明显较高。多种药物使用史的患者的关联分析显示，生物制剂实施前时代组的患者选择了抗肿瘤坏死因子（TNF）-α药物，而生物制剂时代组的患者更倾向于选择其他机制不同于抗TNF-α的生物制剂。综上所述，本研究表明，炎症性肠病的患者特征和治疗偏好在生物制剂实施前后发生了变化。© 2023. Springer Nature Limited.
Many molecular targeted agents, including biologics, have emerged for inflammatory bowel diseases (IBD), but their high prices have prevented their widespread use. This study aimed to reveal the changes in patient characteristics and the therapeutic strategies of IBD before and after the implementation of biologics in Japan, where the unique health insurance system allows patients with IBD and physicians to select drugs with minimum patient expenses. The analysis was performed using a prospective cohort, including IBD expert and nonexpert hospitals in Japan. In this study, patients were classified into two groups according to the year of diagnosis based on infliximab implementation as the prebiologic and biologic era groups. The characteristics of therapeutic strategies in both groups were evaluated using association analysis. This study analyzed 542 ulcerative colitis (UC) and 186 Crohn's disease (CD). The biologic era included 53.3% of patients with UC and 76.2% with CD, respectively. The age of UC (33.9 years vs. 38.8 years, P < 0.001) or CD diagnosis (24.3 years vs. 31.9 years, P < 0.001) was significantly higher in the biologic era group. The association analysis of patients with multiple drug usage histories revealed that patients in the prebiologic era group selected anti-tumor necrosis factor (TNF)-α agents, whereas those in the biologic era group preferred biologic agents with different mechanisms other than anti-TNF-α. In conclusion, this study demonstrated that both patient characteristics and treatment preferences in IBD have changed before and after biologic implementation.© 2023. Springer Nature Limited.