■尽管免疫调节剂广泛用于克罗恩病(CD)患者,目前尚不清楚硫代嘌呤类和甲氨蝶呤(MTX)的治疗结局是否存在差异.
■比较硫嘌呤和MTX在生物初治CD患者中临床失败的风险。
■全国,以人群为基础的研究。
■我们使用了韩国国民健康保险服务的索赔数据。在处理加权的逆概率之后,使用logistic回归和Cox比例风险分析来评估使用硫嘌呤(硫嘌呤组)或MTX(MTX组)治疗的生物初治CD患者的临床失败风险。
■总的来说,在硫代嘌呤和MTX组中,有10,296名成人和儿童患者患有CD[9912(96.3%)和384(3.7%),分别]被包括在内。MTX组诱导缓解失败的比值比(ORs)显著高于硫代嘌呤组[调整后的OR(aOR),1.115;95%置信区间(CI),1.045-1.190;p=0.001]。然而,相反的结果仅在未同时使用类固醇的患者中观察到:MTX组的诱导失败风险低于硫代嘌呤组(aOR,0.740;95%CI,0.673-0.813;p<0.001)。MTX组总体维护失败的风险高于硫代嘌呤组[调整后的风险比(aHR),1.117;95%CI,1.047-1.191;p=0.001]。标准剂量MTX组的总体维持失败的风险高于低剂量MTX组(aHR,1.296;95%CI,1.134-1.480;p<0.001)。根据MTX的给药途径,维修失败的风险没有显着差异。
■硫嘌呤在诱导和维持生物初治CD患者的缓解方面比MTX更有效;然而,同时使用类固醇会影响诱导缓解。
在未使用生物制剂免疫调节剂(IMM)治疗克罗恩病(CD)的克罗恩病患者中,硫代嘌呤和甲氨蝶呤之间的治疗效果差异包括硫代嘌呤和甲氨蝶呤(MTX)等药物。虽然IMM广泛用于CD患者,目前尚不清楚治疗结局是否因IMM的具体类型和剂量以及MTX的给药途径而异.在这项研究中,我们调查了未接受生物治疗的CD患者中硫嘌呤和MTX之间治疗失败的风险.与使用硫嘌呤治疗的患者相比,使用MTX治疗的患者发生维护失败的风险更高。根据硫嘌呤的剂量,治疗失败的风险没有差异。然而,接受标准剂量MTX的患者的维持失败风险高于接受低剂量MTX的患者.根据MTX的给药途径,维护失败的风险没有差异。我们的研究丰富了有关硫嘌呤和MTX对CD患者的治疗效果的知识,并可能帮助临床医生制定适当的治疗计划。
UNASSIGNED: Although immunomodulators are widely prescribed in patients with Crohn\'s disease (CD), it is unclear whether there is a difference in treatment outcomes between thiopurines and methotrexate (MTX).
UNASSIGNED: To compare the risk of clinical failure between thiopurines and MTX in bio-naïve patients with CD.
UNASSIGNED: Nationwide, population-based study.
UNASSIGNED: We used claims data from the Korean National Health Insurance Service. After inverse probability of treatment weighting, logistic regression and Cox proportional hazard analyses were used to evaluate the risk of clinical failure in bio-naïve patients with CD treated with thiopurine (
thiopurine group) or MTX (MTX group).
UNASSIGNED: Overall, 10,296 adult and pediatric patients with CD [9912 (96.3%) and 384 (3.7%) in the thiopurine and MTX groups, respectively] were included. The odds ratios (ORs) of failure to induce remission were significantly higher in the MTX group than in the thiopurine group [adjusted OR (aOR), 1.115; 95% confidence interval (CI), 1.045-1.190; p = 0.001]. However, the opposite result was observed only in patients without concomitant steroid use: the MTX group had a lower risk of induction failure than the thiopurine group (aOR, 0.740; 95% CI, 0.673-0.813; p < 0.001). The risk of overall maintenance failure was higher in the MTX group than in the
thiopurine group [adjusted hazard ratio (aHR), 1.117; 95% CI, 1.047-1.191; p = 0.001]. The risk of overall maintenance failure was higher in the standard-dose MTX group than in the low-dose MTX group (aHR, 1.296; 95% CI, 1.134-1.480; p < 0.001). There was no significant difference in the risk of maintenance failure according to the administration route of MTX.
UNASSIGNED: Thiopurine is more effective than MTX in inducing and maintaining remission in bio-naïve patients with CD; however, the concomitant use of steroids influences inducing remission.
Differences in treatment efficacy between
thiopurine and methotrexate in patients with Crohn’s disease who were not treated with biologics Immunomodulators (IMMs) used in the treatment of Crohn’s disease (CD) include medications such as thiopurine and methotrexate (MTX). Although IMMs are widely prescribed for patients with CD, it remains unclear whether treatment outcomes differ according to the specific types and dosages of IMMs and administration routes of MTX. In this study, we investigated the risk of treatment failure between thiopurines and MTX in CD patients not undergoing biologic treatment. Patients treated with MTX had a higher risk of maintenance failure than those treated with thiopurines. There was no difference in the risk of treatment failure according to the dosage of
thiopurine. However, the risk of maintenance failure was higher in patients receiving standard-dose MTX than in those receiving low-dose MTX. There was no difference in the risk of maintenance failure according to the administration route of MTX. Our study enriches the knowledge regarding the treatment efficacy of thiopurines and MTX for patients with CD and may help clinicians develop appropriate treatment plans.