title: Predictors of response to anti-tumor necrosis factor therapy in ulcerative colitis.
abstract: Ulcerative colitis (UC) is an immune-mediated, chronic inflammatory disease of the large intestine. Its course is characterized by flares of acute inflammation and periods of low-grade chronic inflammatory activity or remission. Monoclonal antibodies against tumor necrosis factor (anti-TNF) are part of the therapeutic armamentarium and are used in cases of moderate to severe UC that is refractory to conventional treatment with corticosteroids and/or immunosuppressants. Therapeutic response to these agents is not uniform and a large percentage of patients either fail to improve (primary non-response) or lose response after a period of improvement (secondary non-response/loss of response). In addition, the use of anti-TNF agents has been related to uncommon but potentially serious adverse effects that preclude their administration or lead to their discontinuation. Finally, use of these medications is associated with a considerable cost for the health system. The identification of parameters that may predict response to anti-TNF drugs in UC would help to better select for patients with a high probability to respond and minimize risk and costs for those who will not respond. Analysis of the major clinical trials and the accumulated experience with the use of anti-TNF drugs in UC has resulted to the report of such prognostic factors. Included are clinical and epidemiological characteristics, laboratory markers, endoscopic indicators and molecular (immunological/genetic) signatures. Such predictive parameters of long-term outcomes may either be present at the commencement of treatment or determined during the early period of therapy. Validation of these prognostic markers in large cohorts of patients with variable characteristics will facilitate their introduction into clinical practice and the best selection of UC patients who will benefit from anti-TNF therapy.
authors.affiliation: Evanthia Zampeli, Gastroenterology Department, Alexandra General Hospital, 11528 Athens, Greece.
authors.forename: Evanthia
authors.initials: E
authors.lastname: Zampeli
authors.affiliation: Evanthia Zampeli, Gastroenterology Department, Alexandra General Hospital, 11528 Athens, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Gizis
authors.affiliation: Evanthia Zampeli, Gastroenterology Department, Alexandra General Hospital, 11528 Athens, Greece.
authors.forename: Spyros I
authors.initials: SI
authors.lastname: Siakavellas
authors.affiliation: Evanthia Zampeli, Gastroenterology Department, Alexandra General Hospital, 11528 Athens, Greece.
authors.forename: Giorgos
authors.initials: G
authors.lastname: Bamias
keywords: Adalimumab; Anti-tumor necrosis factor; Infliximab; Personalized treatment; Predictors of response; Ulcerative colitis