Inflamatuar bağırsak hastalıklarında antiTNF tedavinin retrospektif analizi
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Date
2018
Authors
Şahin, Buket
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Publisher
Uludağ Üniversitesi
Abstract
TNF (Tümör Nekrozis Faktör), inflamatuar bağırsak hastalığı immunopatogenezinde anahtar bir sitokindir. AntiTNF tedaviler (infliksimab ve adalimumab) orta ve ağır aktiviteli hastalarda endikedir. Çalışmamıza Ocak 2012-Mayıs 2017 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı tarafından takipli antiTNF tedavi alan 117 inflamatuar bağırsak hastası (47 ülseratif kolit; 70 crohn hastası) dahil edilmiştir. Vakalarımızdan crohn hastaları ortalama 6 yıl; ülseratif kolit hastaları ise 5 yıl süre ile takip edilmiştir. AntiTNF tedavi alan inflamatuar bağırsak hastalığı tanılı erişkin hastalarda antiTNF tedavi yanıtları (tam remisyon, dirençli hastalık, ölüm) tedavi sonrası gelişen komplikasyonlar ve sağ kalım değerlendirilmesi yapılmıştır. Yaş ortalaması Crohn hastalarında 37.5, Ülseratif Kolit hastalarında 38 olarak hesaplanmıştır. Crohn hastalarının %58.6'sı (n=41), ÜK (Ülseratif Kolit) hastalarının %66.0'sı (n=31) erkektir. ÜK grubunda infliksimab kullananların oranı %34.0 (n=16), Adalimumab kullanma oranı %51.1 (n:24), infliksimab ve adalimumab kullananların oranı %14.9'dur (n=7). İlgili oranlar, Crohn grubunda sırasıyla %45.7 (n=32), %34.3 (n:24) ve %20.0'dir (n=14). 117 inflamatuar bağırsak hastasında antiTNF yanıt oranı %69.6'dır (n:80). 70 crohn hastasında antiTNF tedaviye yanıt oranı %75 (n:51), 47 ülseratif kolit hastasında %61.7'dir (n:29). Çalışmamızda antiTNF yanıt oranı yüksek olmakla birlikte ilaçların her iki hastalık grubu içinde birbirine üstünlüğü görülmemiştir. Çalışmamızda antiTNF ve azotiopurinden oluşan kombine tedavilerin tekli antiTNF tedaviye yanıt açısından bir üstünlüğü görülmemiştir. Yanıt alınan ve alınamayan hastalar arasında hastalık takip süresi, yaş, cinsiyet, başlangıç crp'si (c reaktif peptid), sedimentasyon, hgb (hemoglobin) değeri, tutulum yeri ve şiddeti açısından anlamlı bir farklılık saptanmamıştır. Takip süresince antiTNF kullanımı altında tüberküloz ve malignite başta olmak üzere ciddi bir yan etki görülmemiştir. Sonuç olarak, çalışmamızda orta ve şiddetli inflamatuar bağırsak hastalıklarında antiTNF tedavisinin etkin ve güvenilir olduğu gösterilebilmiştir.
TNF (Tumor Necrosis Factor) is a cytokine which plays a key role in the pathogenesis of inflamatory bowel disease. AntiTNF treatment (infliximab and adalimumab) is indicated for mild to moderate diseases. In our study, we registered 117 patients with inflamatory bowel disease who are treated and followed up in Gastroenterology Department of Uludağ University Faculty Of Medicine between the dates January 2012 and May 2017. Patients with Chron's disease and Ulceratif colitis are followed up 6 and 5 years respectively. Patients who are treated with anti tnf drugs evaluated by the treatment success, complications and survival rate. Median age was 37.5 for Crohn's disease and 38 for Ulceratif colitis. 58.6% (n=41) of patients with Chron's disease and 66.0% (n=31) of patients with ulceratif colitis were male. In UK group, 34.0% (n=16) of all patients received infliximab treatment and 51.1% (n:24) of all patients received adalimumab. 14.9% (n=7) of patients received infliximab and adalimumab both. In Crohn Disease group, the rates were 45.7% (n=32), 34.3% (n=24) and 20.0% (n=14) respectively. In 117 patients with inflamatory bowel disease, response rate to the anti-tnf treatment is 69.9% (n=80). In 70 patients with Chron's disease, response rate to the anti-tnf treatment is 75% (n=51) and in 47 patients with Ulceratif Colitis disease, response rate is 61.7% (n=29). In our study, response rate to the anti-tnf treatment was high and there was no superiority between groups. In addition, combination therapy with anti-tnf and azathiopurine was not superior to the antiTNF treatment only. Regardless of the treatment response, characteristics of the patients such as age, gender, initial crp (c reaktif peptid) values, sedimentation levels, hgb (hemoglobin) values, site of the involvement and severity of the disease were not significantly different. During follow-up period, tuberculosis or malignency was not seen. In our study, we demonstrated that antiTNF treatment was safe and effective in moderate- severe inflamatory bowel disease.
TNF (Tumor Necrosis Factor) is a cytokine which plays a key role in the pathogenesis of inflamatory bowel disease. AntiTNF treatment (infliximab and adalimumab) is indicated for mild to moderate diseases. In our study, we registered 117 patients with inflamatory bowel disease who are treated and followed up in Gastroenterology Department of Uludağ University Faculty Of Medicine between the dates January 2012 and May 2017. Patients with Chron's disease and Ulceratif colitis are followed up 6 and 5 years respectively. Patients who are treated with anti tnf drugs evaluated by the treatment success, complications and survival rate. Median age was 37.5 for Crohn's disease and 38 for Ulceratif colitis. 58.6% (n=41) of patients with Chron's disease and 66.0% (n=31) of patients with ulceratif colitis were male. In UK group, 34.0% (n=16) of all patients received infliximab treatment and 51.1% (n:24) of all patients received adalimumab. 14.9% (n=7) of patients received infliximab and adalimumab both. In Crohn Disease group, the rates were 45.7% (n=32), 34.3% (n=24) and 20.0% (n=14) respectively. In 117 patients with inflamatory bowel disease, response rate to the anti-tnf treatment is 69.9% (n=80). In 70 patients with Chron's disease, response rate to the anti-tnf treatment is 75% (n=51) and in 47 patients with Ulceratif Colitis disease, response rate is 61.7% (n=29). In our study, response rate to the anti-tnf treatment was high and there was no superiority between groups. In addition, combination therapy with anti-tnf and azathiopurine was not superior to the antiTNF treatment only. Regardless of the treatment response, characteristics of the patients such as age, gender, initial crp (c reaktif peptid) values, sedimentation levels, hgb (hemoglobin) values, site of the involvement and severity of the disease were not significantly different. During follow-up period, tuberculosis or malignency was not seen. In our study, we demonstrated that antiTNF treatment was safe and effective in moderate- severe inflamatory bowel disease.
Description
Keywords
Ülseratif kolit, Crohn hastalığı, Chron’s disease, Ulceratif colitis
Citation
Şahin, B. (2018). Inflamatuar bağırsak hastalıklarında antiTNF tedavinin retrospektif analizi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.