CD19+ in intestinal mucosa predict the response to infliximab in Crohn's disease.
OBJECTIVE
Infliximab is an effective treatment for Crohn's disease, yet about 30% of patients have a weak or no response. The aim of the study was to determine if the likelihood of a patient achieving complete remission 3 months after treatment with infliximab can be predicted from immunological parameters measured in peripheral blood and inflamed intestinal mucosa before the treatment.


METHODS
25 patients with Crohn's disease resistant to conventional therapy underwent treatment with infliximab. Samples of peripheral blood and inflamed intestinal mucosa were analyzed by flow-cytometry before infliximab administration. The clinical response was evaluated after 3 months.


RESULTS
At 3 months post-treatment, 11 (44%) patients were in complete remission, while 14 (56%) had no remission. Logistic regression analysis revealed that 50% of patients having 2.29% of CD19+ cells in inflamed intestinal mucosa may be expected to achieve complete remission. If the proportion of CD19+ cells in the inflamed mucosa is 5%, the probability of the patient achieving complete remission following treatment rises to 85%.


CONCLUSIONS
This is the first study which found that a high percentage of CD19+ cells in the inflamed intestinal mucosa of a patient with Crohn's disease may predict long remission after infliximnab therapy.
Department of Gastroenterology, Division of Internal Medicine, University Medical Centre, Ljubljana, Slovenia. ivan.ferkolj@kclj.si
Ivan
I
Ferkolj
Alojz
A
Ihan
Sasa
S
Markovic
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018941:Antigens, CD19 / Q000378:metabolism*; D003106:Colon / Q000378:metabolism / Q000473:pathology; D003424:Crohn Disease / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007082:Ileum / Q000378:metabolism / Q000473:pathology; D000069285:Infliximab; D007413:Intestinal Mucosa / Q000378:metabolism* / Q000473:pathology; D018655:Lymphocyte Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D018941:Antigens, CD19; D005765:Gastrointestinal Agents; D000069285:Infliximab