title: Predictors of tissue healing in ulcerative colitis patients treated with anti-TNF.
abstract: OBJECTIVE
  To identify factors predicting mucosal healing in ulcerative colitis patients treated with anti-TNFα agents with or without azathioprine.
  
  
  METHODS
  In a prospective, multicenter, one-year study biologic naïve patients aged 25-65 years, with corticosteroid-dependent or refractory colitis received combination treatment with anti-TNFα and azathioprine for 6 months followed by anti-TNFα monotherapy. Patients who denied combination therapy or were outside this age range received anti-TNFα monotherapy (controls). Before and at weeks 12 and 54 of treatment the total Mayo score was calculated. Mucosal healing was defined as endoscopic subscore of 0. Mucosal expression of T helper (Th) cell-lineage specific transcription factors (Tbet, Gata3, Rorc, FoxP3) before treatment was also associated with mucosal healing.
  
  
  RESULTS
  Of 67 patients, 58 (86.6%) received combination and 9 (13.4%) anti-TNFα monotherapy. Overall 29 (43.3%) patients achieved mucosal healing; rates were higher in patients receiving combination therapy vs. monotherapy (p=0.03) and in azathioprine naïve vs. exposed patients in the combination group (p=0.01). Mucosal healing was associated with lower pre-treatment mucosal expression of transcription factor Th1-Tbet (p<0.05) and higher expression of Th17-Rorc (p<0.05).
  
  
  CONCLUSIONS
  Mucosal healing was associated with combination therapy, especially in biologic and azathioprine-naïve patients and pre-treatment mucosal expression of specific Th specific transcripting factors (Tbet and Rorc).
authors.affiliation: Gastroenterology Department, Evangelismos Hospital, Athens, Greece. Electronic address: nikos.viazis@gmail.com.
authors.forename: Nikos
authors.initials: N
authors.lastname: Viazis
authors.affiliation: Gastroenterology Department, Evangelismos Hospital, Athens, Greece.
authors.forename: Marios
authors.initials: M
authors.lastname: Giakoumis
authors.affiliation: Academic Department of Gastroenterology, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece.
authors.forename: Giorgos
authors.initials: G
authors.lastname: Bamias
authors.affiliation: Laboratory of Infectious Diseases, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Goukos
authors.affiliation: Gastroenterology Department, Evangelismos Hospital, Athens, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Koukouratos
authors.affiliation: Gastroenterology Department, Evangelismos Hospital, Athens, Greece.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Katopodi
authors.affiliation: Gastroenterology Department, Evangelismos Hospital, Athens, Greece.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Karatzas
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Triantos
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Greece.
authors.forename: Chrisostomos
authors.initials: C
authors.lastname: Tsolias
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Theocharis
authors.affiliation: Laboratory of Infectious Diseases, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece.
authors.forename: George L
authors.initials: GL
authors.lastname: Daikos
authors.affiliation: Academic Department of Gastroenterology, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece.
authors.forename: Spyros D
authors.initials: SD
authors.lastname: Ladas
authors.affiliation: Gastroenterology Department, Evangelismos Hospital, Athens, Greece.
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Karamanolis
authors.affiliation: Gastroenterology Department, Evangelismos Hospital, Athens, Greece.
authors.forename: Gerasimos J
authors.initials: GJ
authors.lastname: Mantzaris
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003113:Colonoscopy; D004359:Drug Therapy, Combination; D005260:Female; D006115:Greece; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use*; D007413:Intestinal Mucosa / Q000187:drug effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057132:Nuclear Receptor Subfamily 1, Group F, Member 3 / Q000235:genetics; D011446:Prospective Studies; D012720:Severity of Illness Index; D020825:T-Box Domain Proteins / Q000378:metabolism; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014945:Wound Healing; D000098815:T-bet Transcription Factor
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D057132:Nuclear Receptor Subfamily 1, Group F, Member 3; C539900:RORC protein, human; D020825:T-Box Domain Proteins; D000098815:T-bet Transcription Factor; D014409:Tumor Necrosis Factor-alpha; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D001379:Azathioprine
keywords: Anti-TNF therapy; Mucosal healing; Ulcerative colitis