Aralik 2023
Inflamatuvar bagirsak hastaligi olan hastalarda immünmodülatör tedaviler güvenli mi? 23 yillik tek merkez deneyimi
Are immunomodulatory therapies safe in patients with inflammatory bowel disease? 23 years of single center experience
- Ana Sayfa
- Sayılar
- Aralik 2023
- Inflamatuvar bagirsak hastaligi olan hastalarda immünmodülatör tedaviler güvenli mi? 23 yillik tek merkez deneyimi...
Özet
Giris ve Amaç: Immünmodülatör ajanlar inflamatuvar bagirsak hastaligi tedavisinde önemli köse taslarindan olup pürin sentezini inhibe eden azatioprin vemetotreksat baslica kullanilmakta olan ajanlardandir. Bu ajanlarin yanitsizlik veya yan etki profilleri nedeni ile her zaman efektif dozda kullanilmalari mümkün olmayabilir. Çalismamizda immünmodülatör ajanlarin güvenlik profilinin degerlendirilmesi amaci ile tedavi kesilmesini gerektirecek yan etkilerin derlendigi23 yillik deneyimin sunulmasi amaçlandi. Gereç ve Yöntem: 1999-2022 yillari arasinda inflamatuvar bagirsak hastaligi tanisi ile takipli olan, halihazirdaanti-tümör nekrozis faktör tedavisi almakta olup tedavi dozunda azatioprin veya metotreksat kullanim geçmisi olan hastalarda tedavi kesilmesini gerektirecekyan etkiler geriye dönük olarak incelendi. Immünmodülatör ajanlari tedavi dozunda almamis olan hastalar ile tedavi kesilmesini gerektirmeyecek durumlaringözlendigi hastalar dislandi. Bulgular: Çalisma grubu 310 Crohn hastaligi ve 100 ülseratif koliti olan hasta olmak üzere 410 hastadan olusuyordu. 325hastada azatioprin, 85 hastada metotreksat kullanim öyküsü mevcuttu. Hastalarin ortalama yasi 42.6 ± 13.4 yil olup 257’si erkek (%62.6) idi. Azatioprin kullanim süresi Crohn hastalarinda 4.2 ± 3.5 yil, ülseratif kolit olan hastalarda 3.0 ± 2.6 yil idi. Azatioprin kullanmis olan hastalarin 18’inde (%5.5), metotreksat kullanmis olan hastalarin 6’sinda (%7) kesilmesini gerektirecek yan etkiler gelistigi tespit edildi ve yan etkilerin tamami 2. derece yan etkilerden olusmaktaydi.Immünmodülatör ajanlarin tedavi birakmayi gerektiren yan etki sikliginda iki grup arasinda anlamli fark saptanmadi (p: 0.59). Her iki tedavi grubunda da takip süresince tedavi iliskili hematolojik veya solid organ malignitesi saptanmadi. Sonuç: Inflamatuvar bagirsak hastaligi tanisi ile takipli hastalarda azatioprinve metotreksat yan etki profili göz önüne alindiginda iki grup arasinda anlamli fark olmayip tedavi süresince yakin takip ile güvenli kullanilabilecek ajanlardir.
Abstract
Background and Aims: Immunomodulatory therapies are important cornerstones in the treatment of inflammatory bowel disease, and azathioprine andmethotrexate are the agents that are mainly use, which inhibit purine synthesis. It may not always be possible to use these agents in effective doses due totheir unresponsiveness or side-effect profiles. In our study, it was aimed to present a 23-year experience compiling side effects requiring treatment discontinuation in order to evaluate the safety profile of immunomodulatory agents. Materials and Method: Adverse effects that necessitate discontinuation of treatment in patients who were followed up with the diagnosis of inflammatory bowel disease between 1999-2022, were currently receiving anti-tumor necrosis factor therapy, and had a history of using azathioprine or methotrexate at the treatment dose were retrospectively evaluated. Patients who did not receiveimmunomodulatory agents at the therapeutic dose and patients who had conditions that did not require discontinuation of treatment were excluded. Results:The study group consisted of 410 patients, 310 patients with Crohn’s disease and 100 patients with ulcerative colitis. Azathioprine was used in 325 patientsand methotrexate was used in 85 patients. The mean age of the patients was 42.6 ± 13.4 years, and 257 of them were male (62.6%). Azathioprine treatmentduration was 4.2 ± 3.5 years in patients with Crohn’s disease and 3.0 ± 2.6 years in patients with ulcerative colitis. Side effects that required discontinuation were determined that 18 (5.5%) patients who used azathioprine and 6 (7%) patients who used methotrexate, and all of side effects consisted of grade 2 sideeffects. There was no significant difference between the two groups in the frequency of side effects (p: 0.59). Treatment-related hematologic or solid organmalignancy were not detected in either treatment group during the follow-up period. Conclusion: Considering the side-effect profile of azathioprine andmethotrexate in patients followed up with the diagnosis of inflammatory bowel disease, there is no significant difference between the two groups, and theseagents can be used safely with closely follow-up during the treatment.
