Serological markers for prediction of response to anti-tumor necrosis factor treatment in Crohn's disease.
OBJECTIVE
The use of monoclonal anti-tumor necrosis factor (TNF) antibodies (infliximab, Remicade) is a new therapeutic approach for severe refractory luminal or fistulizing, Crohn's disease (CD). However, up to 30% of patients do not respond to this treatment. So far, no parameters predictive of response to anti-TNF have been identified. Our aim was to determine whether serological markers ASCA (anti-Saccharomyces cerevisiae antibodies) or pANCA (perinuclear antineutrophil cytoplasmic antibodies) could identify Crohn's patients likely to benefit from anti-TNF therapy.


METHODS
Serum samples of 279 CD patients were analyzed for ASCA and pANCA before anti-TNF therapy. A blinded physician determined clinical response at week 4 (refractory luminal CD) or week 10 (fistulizing CD) after the first infusion of infliximab (5 mg/kg).


RESULTS
Overall, there was no relationship between ASCA or pANCA and response to therapy. However, lower response rates were observed for patients with refractory intestinal disease carrying the pANCA+/ASCA- combination, although this lacked significance (p = 0.067).


CONCLUSIONS
In this cohort of infliximab-treated patients, neither ASCA nor pANCA could predict response to treatment. However, the combination pANCA+/ASCA- might warrant further investigation for its value in predicting nonresponse in patients with refractory luminal disease.
Esters
N
N
Department of Gastroenterology, UZ Gasthuisberg Leuven, Belgium.
Vermeire
S
S
Joossens
S
S
Noman
M
M
Louis
E
E
Belaiche
J
J
De Vos
M
M
Van Gossum
A
A
Pescatore
P
P
Fiasse
R
R
Pelckmans
P
P
Reynaert
H
H
Poulain
D
D
Bossuyt
X
X
Rutgeerts
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D000908:Antibodies, Fungal / Q000032:analysis*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D015331:Cohort Studies; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology*; D005544:Forecasting; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008875:Middle Aged; D012441:Saccharomyces cerevisiae / Q000276:immunology*; D016037:Single-Blind Method; D016896:Treatment Outcome
D019268:Antibodies, Antineutrophil Cytoplasmic; D000908:Antibodies, Fungal; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab