期刊
DIGESTIVE DISEASES AND SCIENCES
卷 67, 期 2, 页码 622-628出版社
SPRINGER
DOI: 10.1007/s10620-021-06990-8
关键词
Inflammatory bowel disease; Frailty; Function; Treatment; Anti-tumor necrosis factor
资金
- Crohn's and Colitis Foundation Career Development Award [568735]
- National Institutes of Health
- Crohn's and Colitis Foundation
- Chleck Family Foundation
This study found that treatment response is a key factor in determining post-treatment frailty in IBD patients. Pre-treatment frailty and prior IBD-related hospitalization were independently predictive of higher likelihood of post-treatment frailty. Effective treatment of inflammatory states in older patients with IBD may improve frailty.
Background Frailty may be a risk factor for complications in inflammatory bowel diseases (IBD) patients. We examined the impact of treatment on IBD patients who were frail prior to treatment and identified predictors of post-treatment change in frailty. Methods In an electronic health record-based cohort of IBD patients initiating anti-tumor necrosis factor (TNF)-alpha agents, we applied a validated claims-based frailty index to determine frailty in the 1 year prior to and after treatment initiation. We characterized treatment non-response using a composite outcome of IBD-related hospitalization, surgery, change in therapy, or initiation of systemic steroids. We constructed multivariable logistic regression models to identify determinants of post-treatment frailty. Results The 1210 patients initiating anti-TNF therapy had a median age of 30 years; 20% were >= 50 years. In the first year after anti-TNF initiation, 40% were non-responders. Many more treatment non-responders were frail in the year following treatment compared with treatment responders (27% vs 7%, p < 0.001). Pre-treatment frailty (OR 2.01, 95% CI 1.35-3.00) and prior IBD-related hospitalization (OR 1.63, 95% CI 1.15-2.30) were independently predictive of higher likelihood of post-treatment frailty. Therapy response was associated with a lower likelihood (OR 0.24, 95% CI 0.16-0.34) of post-treatment frailty. Nearly 85% of patients who were frail prior to treatment demonstrated improvement in frailty following treatment Conclusions Response to anti-TNF therapy is an important determinant of post-treatment frailty in patients with IBD. Our findings suggest that effectively treating inflammatory states in older patients with IBD may improve frailty.
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