Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP], Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain.
J Crohns Colitis. 2020 Jun 19;14(5):694-709. doi: 10.1093/ecco-jcc/jjz195.
Inflammatory bowel diseases [IBD]-ulcerative colitis and Crohn's disease-are commonly treated with biologic drugs. However, only approximately two-thirds of patients have an initial response to these therapies. Personalised medicine has the potential to optimise efficacy, decrease the risk of adverse drug events, and reduce costs by establishing the most suitable therapy for a selected patient.
The present study reviews the potential predictors of short-term primary response to biologic treatment, including not only anti-tumour necrosis factor [TNF] agents [such as infliximab, adalimumab, certolizumab, and golimumab] but also vedolizumab and ustekinumab.
We performed a systematic bibliographical search to identify studies investigating predictive factors of response to biologic therapy.
For anti-TNF agents, most of the evaluated factors have not demonstrated usefulness, and many others are still controversial. Thus, only a few factors may have a potential role in the prediction of the response, including disease behaviour/phenotype, disease severity, C-reactive protein, albumin, cytokine expression in serum, previous anti-TNF therapy, some proteomic markers, and some colorectal mucosa markers. For vedolizumab, the availability of useful predictive markers seems to be even lower, with only some factors showing a limited value, such as the expression of α4β7 integrin in blood, the faecal microbiota, some proteomic markers, and some colorectal mucosa markers. Finally, in the case of ustekinumab, no predictive factor has been reported yet to be helpful in clinical practice.
In summary, currently no single marker fulfils all criteria for being an appropriate prognostic indicator of response to any biologic treatment in IBD.
炎症性肠病（IBD）-溃疡性结肠炎和克罗恩病-通常采用生物药物治疗。然而，只有大约三分之二的患者对这些治疗有初始反应。个性化医学有可能通过为选定的患者确定最合适的治疗方法来优化疗效、降低药物不良事件的风险并降低成本。
本研究综述了生物治疗短期原发性反应的潜在预测因素，不仅包括抗肿瘤坏死因子（TNF）药物（如英夫利昔单抗、阿达木单抗、certolizumab 和 golimumab），还包括 vedolizumab 和 ustekinumab。
我们进行了系统的文献检索，以确定研究生物治疗反应预测因素的研究。
对于抗 TNF 药物，大多数评估的因素并没有显示出有用性，许多其他因素仍然存在争议。因此，只有少数因素可能在预测反应方面具有潜在作用，包括疾病行为/表型、疾病严重程度、C 反应蛋白、白蛋白、血清细胞因子表达、先前的抗 TNF 治疗、一些蛋白质组学标记物和一些结直肠黏膜标记物。对于 vedolizumab，似乎没有更有用的预测标志物，只有一些因素显示出有限的价值，例如血液中 α4β7 整合素的表达、粪便微生物群、一些蛋白质组学标记物和一些结直肠黏膜标记物。最后，在 ustekinumab 的情况下，目前尚未报道任何有助于临床实践的预测因子。
总的来说，目前没有单一的标志物能够满足作为 IBD 任何生物治疗反应的适当预后指标的所有标准。
