Previous exposure to biologics and C-reactive protein are associated with the response to tacrolimus in inflammatory bowel disease.
OBJECTIVE
Inflammatory bowel disease is a chronic disorder of the gastrointestinal tract. Tacrolimus is a calcineurin inhibitor used in the prophylaxis of rejection after a solid organ transplant. There is some evidence for its use in inflammatory bowel disease, although there is a lack of information about the patients who will benefit the most with this drug and the prognostic factors for a favorable response.


METHODS
We performed a multicentric retrospective study evaluating all the patients who have received tacrolimus in the last 10 years as a treatment for IBD in our area.


RESULTS
A total of 20 patients, 12 with Crohn's disease and 8 with ulcerative colitis, were included in four hospitals. The two most common indications were steroid-dependency and fistulizing Crohn's disease. The median time receiving tacrolimus was 11 months. In 12 patients the treatment was stopped. The main reasons for drug withdrawal were absence or loss of response. The median clinical follow-up was 35.5 months. Overall, a 25% achieved clinical remission and 40% were in partial response. Biologics-naïve patients demonstrated a significantly better remission rate as compared with those that were not (80 vs 7%). Patients who achieved remission were more likely to have a significant reduction in C-reactive protein values 1 month after starting the drug. Seven patients required surgery during the follow- up period.


CONCLUSIONS
Patients naïve to biologics showed a significantly better response to tacrolimus. A reduction in C-reactive protein one month after starting this drug was associated with clinical remission.
Aparato Digestivo, Hospital de Galdakao, España.
Iago
I
Rodríguez-Lago
Aparato Digestivo, Hospital Universitario de Cruces, España.
Olga
O
Merino
Aparato Digestivo, Complejo Hospitalario de Navarra, España.
Óscar
Ó
Nantes
Aparato Digestivo, Hospital Universitario de Basurto, España.
Carmen
C
Muñoz
Unidad de Investigación., Hospital de Galdakao, España.
Urko
U
Aguirre
Aparato Digestivo, Hospital de Galdakao, España.
José Luis
JL
Cabriada
D000293:Adolescent; D000328:Adult; D001688:Biological Products / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D001688:Biological Products; D007166:Immunosuppressive Agents; D002097:C-Reactive Protein; D016559:Tacrolimus