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- 저자 : Sandeep Mundhra (검색결과 1 건)
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Peeyush Kumar,Sudheer K. Vuyyuru,Prasenjit Das,Bhaskar Kante,Mukesh Kumar Ranjan,David Mathew Thomas,Sandeep Mundhra,Pabitra Sahu,Pratap Mouli Venigalla,Saransh Jain,Sandeep Goyal,Rithvik Golla,Shubi 대한장연구학회 2023 Intestinal Research Vol.21 No.4
Background/Aims: Evidence on predictors of primary nonresponse (PNR), and secondary loss of response (SLR) to anti-tumor necrosis factor (anti-TNF) agents in inflammatory bowel disease is scarce from Asia. We evaluated clinical/biochemical/molecular markers of PNR/SLR in ulcerative colitis (UC) and Crohn’s disease (CD).Methods: Inflammatory bowel disease patients treated with anti-TNF agents (January 2005–October 2020) were ambispectively included. Data concerning clinical and biochemical predictors was retrieved from a prospectively maintained database. Immunohistochemistry for expression of oncostatin M (OSM), OSM receptor (OSM-R), and interleukin-7 receptor (IL-7R) were done on pre anti-TNF initiation mucosal biopsies.Results: One-hundred eighty-six patients (118 CD, 68 UC: mean age, 34.1±13.7 years; median disease duration at anti-TNF initiation, 60 months; interquartile range, 28–100.5 months) were included. PNR was seen in 17% and 26.5% and SLR in 47% and 28% CD and UC patients, respectively. In CD, predictors of PNR were low albumin (<i>P</i><0.001), postoperative recurrence (<i>P</i>=0.001) and high IL-7R expression (<i>P</i><0.027) on univariate; and low albumin alone (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.03–0.28; <i>P</i><0.001) on multivariate analysis respectively. Low albumin (HR, 0.31; 95% CI, 0.15–0.62; <i>P</i>=0.001) also predicted SLR. In UC, predictors of PNR were low albumin (<i>P</i><0.001), and high C-reactive protein (<i>P</i><0.001), OSM (<i>P</i><0.04) and OSM-R (P=0.07) stromal expression on univariate; and low albumin alone (HR, 0.11; 95% CI, 0.03–0.39; <i>P</i>=0.001) on multivariate analysis respectively. Conclusions: Low serum albumin at baseline significantly predicted PNR in UC and PNR/SLR in CD patients. Mucosal markers of PNR were high stromal OSM/OSM-R in UC and high IL-7R in CD patients.
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