title: An increase in serum tumour necrosis factor-α during anti-tumour necrosis factor-α therapy for Crohn's disease - A paradox or a predictive index?
abstract: BACKGROUND
  Soluble tumour necrosis factor-α (sTNF-α) has been reported to increase in the course of anti-TNF-α therapy for rheumatoid and skin diseases.
  
  
  OBJECTIVE
  To assess changes in sTNF-α and clinical efficacy of anti-TNF-α agents in Crohn's disease (CD).
  
  
  METHODS
  Sixty-four patients on infliximab or adalimumab were analyzed. Clinical outcomes were assessed by using CD Activity Index after the induction therapy and at week 52. sTNF-α was measured before and after the induction therapy with high-sensitivity immunoassay.
  
  
  RESULTS
  In the majority of patients, sTNF-α increased significantly. Those with the greatest increase were more likely to experience long-term response, were more often treated with infliximab, had less frequently isolated small bowel CD, and tended to have sTNF-α levels at baseline that correlated with C-reactive protein.
  
  
  CONCLUSIONS
  Neutralization of sTNF-α does not seem to be critical for the efficacy of anti-TNF-α therapy in CD. Paradoxically - an increase in sTNF-α may reflect an ongoing process that is beneficial for the clinical outcome.
authors.affiliation: Department of Gastroenterology, Human Nutrition and Internal Diseases, Poznan University of Medical Sciences, Heliodor Swiecicki Hospital, Poznan, Poland. Electronic address: piotr.eder@op.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Eder
authors.affiliation: Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Korybalska
authors.affiliation: Department of Gastroenterology, Human Nutrition and Internal Diseases, Poznan University of Medical Sciences, Heliodor Swiecicki Hospital, Poznan, Poland.
authors.forename: Liliana
authors.initials: L
authors.lastname: Łykowska-Szuber
authors.affiliation: Department of Gastroenterology, Human Nutrition and Internal Diseases, Poznan University of Medical Sciences, Heliodor Swiecicki Hospital, Poznan, Poland.
authors.forename: Kamila
authors.initials: K
authors.lastname: Stawczyk-Eder
authors.affiliation: Department of Gastroenterology, Human Nutrition and Internal Diseases, Poznan University of Medical Sciences, Heliodor Swiecicki Hospital, Poznan, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Krela-Kaźmierczak
authors.affiliation: Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Łuczak
authors.affiliation: Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Natasza
authors.initials: N
authors.lastname: Czepulis
authors.affiliation: Department of Gastroenterology, Human Nutrition and Internal Diseases, Poznan University of Medical Sciences, Heliodor Swiecicki Hospital, Poznan, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Linke
authors.affiliation: Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Witowski
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage*; D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage*; D008297:Male; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000097:blood*; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000069285:Infliximab; D000068879:Adalimumab
keywords: Biological therapy; Cytokines; Gastroenterology; Inflammatory bowel disease