☆ 4.6 Article

Early anti-TNF/immunomodulator therapy is associated with better long-term clinical outcomes in Asian patients with Crohn's disease with poor prognostic factors

PLOS ONE (2017)

Journal

PLOS ONE

Volume 12, Issue 5, Pages -

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PUBLIC LIBRARY SCIENCE

DOI: 10.1371/journal.pone.0177479

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Abstract

Although early treatment of Crohn's disease (CD) patients with anti-tumor necrosis factor (TNF) agents or immunomodulators (IMs) may improve long-term outcomes, especially those with poor prognostic factors, their effectiveness in Asians remains unclear. In this study, Korean patients with CD naive to both intestinal surgery and intestinal complications, and with at least two risk factors for progression (diagnosis at age <40 years, systemic corticosteroid treatment <3 months after diagnosis, and perianal fistula at diagnosis) were retrospectively analyzed. Patients were classified into those who started anti-TNFs, or IMs but not anti-TNFs, within 2 years of diagnosis, and those who started anti-TNFs and/or IMs later. Their probabilities of intestinal surgery and intestinal complications were compared. A total of 670 patients were enrolled, 79 in the early anti-TNF, 286 in the early IM, and 305 in the late treatment group. Kaplan-Meier analysis with the log-rank test showed that from starting anti-TNFs/IMs, times to intestinal surgery (P < 0.001), stricturing complications (P = 0.002), and penetrating complications (P < 0.001) were significantly longer in the early anti-TNF/IM groups than in the late treatment group. Multivariate Cox regression analysis showed that, from starting anti-TNFs/IMs, late anti-TNF/IM treatment was independently associated with higher risks of intestinal surgery (adjusted hazard ratio [aHR] 2.321, 95% confidence interval [CI] 1.503-3.584, P < 0.001), behavioral progression (aHR 2.001, 95% CI 1.449-2.763, P < 0.001), stricturing complications (aHR 1.736, 95% CI 1.209-2.493, P = 0.003), and penetrating complications (aHR 3.315, 95% CI 2.094-5.249, P < 0.001) than early treatment. In conclusion, treatment of Asian CD patients having poor prognostic factors with anti-TNFs/IMs within 2 years of diagnosis is associated with better clinical outcomes than later treatment.

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Development of a Prediction Model for Short-Term Remission of Patients with Crohn's Disease Treated with Anti-TNF Drugs

Rosario Medina-Medina, Eva Iglesias-Flores, Jose M. Benitez, Sandra Marin-Pedrosa, Isabel Salgueiro-Rodriguez, Clara I. Linares, Sandra Gonzalez-Rubio, Pilar Soto-Escribano, Beatriz Gros, Manuel L. Rodriguez-Peralvarez, Jose L. Cabriada, Maria Chaparro, Javier P. Gisbert, Eduardo Chicano-Galvez, Ignacio Ortea, Gustavo Ferrin, Valle Garcia-Sanchez, Patricia Aguilar-Melero

Summary: Therapy with anti-TNF has transformed the treatment of Crohn's disease, but long-term efficacy is limited and adverse events can occur. This study aimed to find reliable markers to predict response to anti-TNF drugs in Crohn's disease patients. By comparing protein expression profiles in plasma samples, we identified 18 differentially expressed proteins, including vinculin, that may serve as biomarkers for short-term remission. Plasma vinculin levels, along with other factors such as baseline CD Activity Index, corticosteroid induction, and bowel resection, can predict non-short-term remission.

INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES (2023)