Department of Gastroenterology, Medical School, University Hospital of Heraklion, University of Crete, P.O. BOX 1352, 71110, Heraklion, Crete, Greece.
Department of Basic Medical Sciences, Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Int J Colorectal Dis. 2022 Mar;37(3):639-646. doi: 10.1007/s00384-021-04091-6. Epub 2022 Jan 11.
The detection of antinuclear antibodies (ANA) in serum of patients with inflammatory bowel disease (IBD) has been associated with a worse response to anti-TNF therapy and the development of cutaneous or arthritic manifestations. The aim of this study was to investigate a possible association of serum ANA with infliximab (IFX) and adalimumab (ADA) trough levels (TLs) and anti-drug antibodies in IBD patients treated with IFX or ADA.
Consecutive IBD patients under maintenance therapy with IFX or ADA in whom there was at least one available measurement of anti-TNF TLs, antibodies to IFX or ADA, and ANA in serum were included. The correlation of ANA positivity with demographics, clinical characteristics, treatment, TLs and anti-drug antibodies, of all patients was analyzed.
One hundred two IBD patients under maintenance therapy with IFX or ADA were enrolled. Of these, 53 (52%) were ANA positive with 28 (27.5%) positive also to anti-ds-DNA in serum. In the univariate analysis ANA positivity was found to be correlated with age (P = 0.008), female gender (P = 0.03), duration of treatment (P = 0.06), arthralgias (P = 0.04) and TLs (P = 0.005). However, in multivariate logistic regression analysis only age and TLs remained significantly associated with the presence of ANA positivity (P = 0.04 and P = = 0.006, respectively). No significant association of ANA positivity with the development of cutaneous or rheumatological manifestations was found.
In IBD patients under maintenance therapy with anti-TNF ANA positivity is associated with lower TLs. The clinical significance of this finding remains to be defined in future larger prospective studies.
在炎症性肠病（IBD）患者的血清中检测到抗核抗体（ANA）与对 TNF 治疗的反应较差以及出现皮肤或关节表现有关。本研究的目的是研究 IBD 患者在接受英夫利昔单抗（IFX）或阿达木单抗（ADA）治疗时，血清 ANA 与 IFX 或 ADA 谷浓度（TLs）和抗药物抗体之间是否存在关联。
纳入了连续接受 IFX 或 ADA 维持治疗且至少有一次血清抗 TNF TLs、IFX 或 ADA 抗体和 ANA 可用的 IBD 患者。分析了所有患者 ANA 阳性与人口统计学、临床特征、治疗、TLs 和抗药物抗体之间的相关性。
共纳入 102 例接受 IFX 或 ADA 维持治疗的 IBD 患者。其中，53 例（52%）ANA 阳性，28 例（27.5%）ANA 阳性，同时血清抗 ds-DNA 阳性。单因素分析发现，ANA 阳性与年龄（P=0.008）、女性（P=0.03）、治疗持续时间（P=0.06）、关节痛（P=0.04）和 TLs（P=0.005）相关。然而，在多因素逻辑回归分析中，只有年龄和 TLs 与 ANA 阳性的存在显著相关（P=0.04 和 P=0.006）。ANA 阳性与皮肤或风湿表现的发展无显著相关性。
在接受抗 TNF 维持治疗的 IBD 患者中，ANA 阳性与 TLs 较低有关。这一发现的临床意义有待未来更大规模的前瞻性研究进一步明确。
