Response to medical treatment in patients with Crohn's disease: the role of NOD2/CRAD15, disease phenotype, and age of diagnosis.
OBJECTIVE
Factors influencing response to medications in Crohn's disease (CD) patients are not fully understood. We aimed to evaluate the relationships between NOD2/CARD15 mutations, disease phenotype and age of CD diagnosis and response to medical treatment with systemic steroids, azathioprine (AZA) or 6-mercaptopurine (6-MP), and infliximab.


METHODS
A retrospective medical records analysis was made of patients previously tested for the CD-associated NOD2/CARD15 mutations. Harvey- Bradshaw score was used to assess remission or response to therapy.


RESULTS
CD-associated NOD2/CARD15 mutations were not related to the rate of steroids dependency or clinical response to AZA/6-MP and infliximab. Steroid dependency was associated with colonic involvement. Thirty-three of 127 (26%) patients with colonic disease were steroid dependent, compared with 7/72 (9.7%) patients with isolated small bowel disease (ISBD), (p = 0.009). ISBD was mildly associated with a better remission/response to AZA/6-MP treatment. Disease behavior and age of diagnosis were not related to response to therapy.


CONCLUSIONS
Response to treatment with systemic steroids, AZA/6-MP and infliximab are not related to NOD2/CARD15 mutations, age of diagnosis and disease behavior. Patients with colonic disease have higher rates of steroid dependency.
Weiss
B
B
Division of Pediatric Gastroenterology and Nutrition, Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel. weissb@sheba.health.gov.il
Lebowitz
O
O
Fidder
H H
HH
Maza
I
I
Levine
A
A
Shaoul
R
R
Reif
S
S
Bujanover
Y
Y
Karban
A
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D020022:Genetic Predisposition to Disease; D006801:Humans; D000069285:Infliximab; D007557:Israel; D008137:Longitudinal Studies; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D008875:Middle Aged; D009154:Mutation; D053473:Nod2 Signaling Adaptor Protein / Q000235:genetics*; D010641:Phenotype; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; C429018:NOD2 protein, human; D053473:Nod2 Signaling Adaptor Protein; D013256:Steroids; D000069285:Infliximab; D015122:Mercaptopurine; D001379:Azathioprine
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