Gut and Gastroenterology

Abstract

Evaluation of Loss of Response to Anti-Tumor Necrosis Factor-α Biologic Agents in Patients with Crohn’s Disease: A Multicenter, Retrospective Study

Author(s): Tomoya Sugiyama, Makoto Sasaki, Shoko Nakagawa, Kazunori Adachi, Takashi Yoshimine, Yoshiharu Yamaguchi, Shinya Izawa, Mari Mizuno, Sayuri Yamamoto, Masahide Ebi, Yasushi Funaki, Naotaka Ogasawara, Yusuke Inoue, Masayuki Endo, Yoshihide Kimura, Tomonori Yamada, Yoshikazu Hirata, Tsutomu Mizoshita, Hiromi Kataoka, Kunio Kasugai

Study background: Anti tumor necrosis factor-α is thought to play an important role in the treatment of Crohn’s disease. However, loss of response to anti tumor necrosis factor-α remains problematic. We aimed to assess loss of response to anti tumor necrosis factor-α in the treatment of Crohn’s disease and clarify factors associated with loss of response. 
Methods: We analyzed loss of response in 128 patients with Crohn’s disease from multiple centers. All the patients were naïve to anti tumor necrosis factor-α at the time of the initial treatment. The Kaplan-Meier method, Rank test, and Cox regression analyses were used in the statistical analyses. 
Results: Twenty-five percent of the patients were women, and the median age of the patients was 31 years (interquartile range 22.0-43.2 years). Loss of response to infliximab and adalimumab treatments was recognized in 26 (28.8%) of 90 patients and in 7 (18.4%) of 38 patients, respectively. In the multivariate Cox regression analysis, the presence of an ileitis lesion and a high C-reactive protein level (≥2.25 mg/dL) before treatment induction were identified as independent risk factors for predicting loss of response (hazard ratio=2.563, p<0.05 and hazard ratio=5.317, p<0.05, respectively). 
Conclusion: The C-reactive protein level of the patients prior to anti tumor necrosis factor-α therapy is an important factor to consider when predicting loss of response in anti tumor necrosis factor-α naïve patients.

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