title: Serological markers for prediction of response to anti-tumor necrosis factor treatment in Crohn's disease.
abstract: 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.
authors.affiliation: Department of Gastroenterology, UZ Gasthuisberg Leuven, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Esters
authors.forename: S
authors.initials: S
authors.lastname: Vermeire
authors.forename: S
authors.initials: S
authors.lastname: Joossens
authors.forename: M
authors.initials: M
authors.lastname: Noman
authors.forename: E
authors.initials: E
authors.lastname: Louis
authors.forename: J
authors.initials: J
authors.lastname: Belaiche
authors.forename: M
authors.initials: M
authors.lastname: De Vos
authors.forename: A
authors.initials: A
authors.lastname: Van Gossum
authors.forename: P
authors.initials: P
authors.lastname: Pescatore
authors.forename: R
authors.initials: R
authors.lastname: Fiasse
authors.forename: P
authors.initials: P
authors.lastname: Pelckmans
authors.forename: H
authors.initials: H
authors.lastname: Reynaert
authors.forename: D
authors.initials: D
authors.lastname: Poulain
authors.forename: X
authors.initials: X
authors.lastname: Bossuyt
authors.forename: P
authors.initials: P
authors.lastname: Rutgeerts
mesh_terms: 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
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000908:Antibodies, Fungal; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab