Predictors of tissue healing in ulcerative colitis patients treated with anti-TNF

• Published in: Digestive and liver disease Vol. 49; no. 1; pp. 29 - 33
• Main Authors: Viazis, Nikos, Giakoumis, Marios, Bamias, Giorgos, Goukos, Dimitris, Koukouratos, Theodoros, Katopodi, Konstantina, Karatzas, Pantelis, Triantos, Christos, Tsolias, Chrisostomos, Theocharis, Georgios, Daikos, George L, Ladas, Spyros D, Karamanolis, Dimitrios G, Mantzaris, Gerasimos J
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-01-2017
• Subjects: Adalimumab - therapeutic use; Adult; Aged; Anti-TNF therapy; Antibodies, Monoclonal - therapeutic use; Azathioprine - therapeutic use; Colitis, Ulcerative - drug therapy; Colonoscopy; Drug Therapy, Combination; Female; Gastroenterology and Hepatology; Greece; Humans; Immunosuppressive Agents - therapeutic use; Infliximab - therapeutic use; Intestinal Mucosa - drug effects; Logistic Models; Male; Middle Aged; Mucosal healing; Nuclear Receptor Subfamily 1, Group F, Member 3 - genetics; Prospective Studies; Severity of Illness Index; T-Box Domain Proteins - metabolism; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Ulcerative colitis; Wound Healing; Anti-TNF therapy; Mucosal healing; Ulcerative colitis
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2016.10.008

Abstract Aim To identify factors predicting mucosal healing in ulcerative colitis patients treated with anti-TNFα agents with or without azathioprine. Methods In a prospective, multicenter, one-year study biologic naïve patients aged 25–65 years, with corticosteroid-dependent or refractory colitis received combination treatment with anti-TNFα and azathioprine for 6 months followed by anti-TNFα monotherapy. Patients who denied combination therapy or were outside this age range received anti-TNFα monotherapy (controls). Before and at weeks 12 and 54 of treatment the total Mayo score was calculated. Mucosal healing was defined as endoscopic subscore of 0. Mucosal expression of T helper (Th) cell-lineage specific transcription factors (Tbet, Gata3, Rorc, FoxP3) before treatment was also associated with mucosal healing. Results Of 67 patients, 58 (86.6%) received combination and 9 (13.4%) anti-TNFα monotherapy. Overall 29 (43.3%) patients achieved mucosal healing; rates were higher in patients receiving combination therapy vs. monotherapy (p = 0.03) and in azathioprine naïve vs. exposed patients in the combination group (p = 0.01). Mucosal healing was associated with lower pre-treatment mucosal expression of transcription factor Th1–Tbet (p < 0.05) and higher expression of Th17–Rorc (p < 0.05). Conclusions Mucosal healing was associated with combination therapy, especially in biologic and azathioprine-naïve patients and pre-treatment mucosal expression of specific Th specific transcripting factors (Tbet and Rorc).