抗TNF治疗或降低IBD患者的急性动脉事件风险
创作:爱的抉择 审核:szx 2019年09月11日
  • 2010-2014年间,随访177827名法国成年IBD患者,以评估硫嘌呤类药物和抗TNF药物暴露对IBD患者急性动脉事件风险的影响;
  • 随访期间共发生4145例急性动脉事件(包括缺血病心脏病、脑血管病、外周动脉疾病);
  • 相比于未暴露患者,抗TNF药物暴露与急性动脉事件风险降低相关,而硫嘌呤类药物暴露与急性动脉事件风险无显著关联;
  • 在接受抗TNF药物治疗的男性克罗恩病患者中,急性动脉事件风险降低幅度最大。
主编推荐语
szx
IBD患者发生急性动脉事件的风险增加。来自Gut上发表的一项队列研究结果,对近20万名法国IBD患者进行了5年随访后发现,接受过抗TNF药物治疗的患者的急性动脉事件风险显著降低。
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Gut [IF:19.819]

Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

与IBD治疗相关的急性动脉事件风险:法国全国队列研究

10.1136/gutjnl-2019-318932

2019-08-24, Article

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Objective : Patients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.
Design : Patients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.
Results : Among 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn’s disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).
Conclusion : Exposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.

First Authors:
Julien Kirchgesner

Correspondence Authors:
Julien Kirchgesner

All Authors:
Julien Kirchgesner,Nynne Nyboe Andersen,Fabrice Carrat,Tine Jess,Laurent Beaugerie,BERENICE study group

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