Yoshida Atsushi, Matsuoka Katsuyoshi, Ueno Fumiaki, Morizane Toshio, Endo Yutaka, Hibi Toshifumi
Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan.
Department of Gastroenterology and Hepatology, Toho University Sakura Medical Center, Chiba, Japan.
Inflamm Intest Dis. 2021 May;6(2):117-122. doi: 10.1159/000515361. Epub 2021 Apr 13.
Anti-tumor necrosis factor-α (TNF-α) agents are effective for moderately to severely active ulcerative colitis (UC). Nonetheless, a proportion of patients fail to respond to these agents as therapy for induction of remission. Recent studies indicated that perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) may predict response to anti-TNF-α agents in UC patients. However, whether PR3-ANCA can predict primary nonresponse (PNR) to anti-TNF-α agents has not yet been evaluated. The aim of this study was to examine whether PR3-ANCA can predict PNR to anti-TNF-α in UC patients.
This was a single-center retrospective study. Data were extracted from 50 patients with UC who had measurements of PR3-ANCA and received anti-TNF-α agents for the first time as induction therapy. The primary endpoint of this study was a proportion of patients with PNR stratified by PR3-ANCA positivity. PNR to anti-TNF-α agents was defined as failure to achieve reduction in partial Mayo score by 2 or more points and change to other therapeutics within 6 weeks.
Fourteen (28%) of the 50 patients were PR3-ANCA positive. Seventeen (34%) of the 50 patients demonstrated PNR. Eleven (78.6%) of the 14 PR3-ANCA-positive patients demonstrated PNR, while 6 (16.7%) of the 36 PR3-ANCA-negative patients demonstrated PNR. Multivariate analysis demonstrated that PR3-ANCA positivity was associated with PNR to anti-TNF-α agents (odds ratio 19.29, 95% CI: 3.30-172.67; = 0.002).
PR3-ANCA positivity can predict PNR to anti-TNF-α agents in UC patients.
抗肿瘤坏死因子-α（TNF-α）药物对中度至重度活动性溃疡性结肠炎（UC）有效。尽管如此，仍有一部分患者在作为诱导缓解治疗时对这些药物无反应。最近的研究表明，核周抗中性粒细胞胞浆抗体（p-ANCA）可能预测UC患者对抗TNF-α药物的反应。然而，蛋白酶3-抗中性粒细胞胞浆抗体（PR3-ANCA）能否预测对抗TNF-α药物的原发性无反应（PNR）尚未得到评估。本研究的目的是检验PR3-ANCA能否预测UC患者对抗TNF-α的PNR。
这是一项单中心回顾性研究。数据来自50例UC患者，这些患者检测了PR3-ANCA并首次接受抗TNF-α药物作为诱导治疗。本研究的主要终点是按PR3-ANCA阳性分层的PNR患者比例。对抗TNF-α药物的PNR定义为在6周内未能使部分梅奥评分降低2分或更多分且改为其他治疗方法。
50例患者中有14例（28%）PR3-ANCA阳性。50例患者中有17例（34%）表现为PNR。14例PR3-ANCA阳性患者中有11例（78.6%）表现为PNR，而36例PR3-ANCA阴性患者中有6例（16.7%）表现为PNR。多变量分析表明，PR3-ANCA阳性与对抗TNF-α药物的PNR相关（比值比19.29，95%CI：3.30-172.67；P = 0.002）。
PR3-ANCA阳性可预测UC患者对抗TNF-α药物的PNR。
