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Association between serum tumor necrosis factor-alpha level and the efficacy of infliximab for refractory pouchitis after restorative proctocolectomy in patients with ulcerative colitis

Objectives: Although the aetiology of pouchitis after restorative proctocolectomy in ulcerative colitis (UC) remains unknown, infliximab (IFX) is often effective for this condition. However, indicators and predictors of treatment efficacy remain unclear. In this study, the association between serum...

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Autores principales: Uchino, Motoi, Ikeuchi, Hiroki, Bando, Toshihiro, Hirata, Akihiro, Chohno, Teruhiro, Sasaki, Hirofumi, Horio, Yuki, Nakamura, Shiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japan Society of Coloproctology 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768686/
https://www.ncbi.nlm.nih.gov/pubmed/31583309
http://dx.doi.org/10.23922/jarc.2016-008
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author Uchino, Motoi
Ikeuchi, Hiroki
Bando, Toshihiro
Hirata, Akihiro
Chohno, Teruhiro
Sasaki, Hirofumi
Horio, Yuki
Nakamura, Shiro
author_facet Uchino, Motoi
Ikeuchi, Hiroki
Bando, Toshihiro
Hirata, Akihiro
Chohno, Teruhiro
Sasaki, Hirofumi
Horio, Yuki
Nakamura, Shiro
author_sort Uchino, Motoi
collection PubMed
description Objectives: Although the aetiology of pouchitis after restorative proctocolectomy in ulcerative colitis (UC) remains unknown, infliximab (IFX) is often effective for this condition. However, indicators and predictors of treatment efficacy remain unclear. In this study, the association between serum tumor necrosis factor-alpha (TNF-α) levels and refractory pouchitis was evaluated. Methods: We conducted a prospective study between January 2014 and April 2016. Patients with antibiotic-refractory pouchitis were treated with IFX. Serum TNF-α levels were measured before IFX induction. Diagnoses were confirmed using the modified Pouchitis Disease Activity Index (m-PDAI). Responders were defined as patients with an m-PDAI score lower than 5. Recurrence was defined as an m-PDAI score exceeding 5 during maintenance treatment or a need for additional treatments. Associations between serum TNF-α level and efficacy of IFX during 52 weeks of maintenance therapy were evaluated. Results: Thirteen patients were eligible for this study. The short-term efficacy was 8/13 (61.5%). Four patients could not be maintained with IFX alone. The cumulative maintenance ratio was 30.8%/52 weeks, and the cut-off value for serum TNF-α was 1.93 pg/mL for short-term response. Although there was no significant association between serum TNF-α and treatment response, IFX treatment was unsuccessful for all five patients with TNF-α levels below 1.93 pg/mL, including four short-term non-responders and one long-term non-responder. Conclusion: Serum TNF-α level was not an independent predictor of IFX efficacy for refractory pouchitis. However, IFX may be effective for patients with elevated serum TNF-α. Future studies should assess this possibility.
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spelling pubmed-67686862019-10-03 Association between serum tumor necrosis factor-alpha level and the efficacy of infliximab for refractory pouchitis after restorative proctocolectomy in patients with ulcerative colitis Uchino, Motoi Ikeuchi, Hiroki Bando, Toshihiro Hirata, Akihiro Chohno, Teruhiro Sasaki, Hirofumi Horio, Yuki Nakamura, Shiro J Anus Rectum Colon Original Research Article Objectives: Although the aetiology of pouchitis after restorative proctocolectomy in ulcerative colitis (UC) remains unknown, infliximab (IFX) is often effective for this condition. However, indicators and predictors of treatment efficacy remain unclear. In this study, the association between serum tumor necrosis factor-alpha (TNF-α) levels and refractory pouchitis was evaluated. Methods: We conducted a prospective study between January 2014 and April 2016. Patients with antibiotic-refractory pouchitis were treated with IFX. Serum TNF-α levels were measured before IFX induction. Diagnoses were confirmed using the modified Pouchitis Disease Activity Index (m-PDAI). Responders were defined as patients with an m-PDAI score lower than 5. Recurrence was defined as an m-PDAI score exceeding 5 during maintenance treatment or a need for additional treatments. Associations between serum TNF-α level and efficacy of IFX during 52 weeks of maintenance therapy were evaluated. Results: Thirteen patients were eligible for this study. The short-term efficacy was 8/13 (61.5%). Four patients could not be maintained with IFX alone. The cumulative maintenance ratio was 30.8%/52 weeks, and the cut-off value for serum TNF-α was 1.93 pg/mL for short-term response. Although there was no significant association between serum TNF-α and treatment response, IFX treatment was unsuccessful for all five patients with TNF-α levels below 1.93 pg/mL, including four short-term non-responders and one long-term non-responder. Conclusion: Serum TNF-α level was not an independent predictor of IFX efficacy for refractory pouchitis. However, IFX may be effective for patients with elevated serum TNF-α. Future studies should assess this possibility. The Japan Society of Coloproctology 2018-05-25 /pmc/articles/PMC6768686/ /pubmed/31583309 http://dx.doi.org/10.23922/jarc.2016-008 Text en Copyright © 2017 by The Japan Society of Coloproctology https://creativecommons.org/licenses/by-nc-nd/4.0/ Journal of the Anus, Rectum and Colon is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research Article
Uchino, Motoi
Ikeuchi, Hiroki
Bando, Toshihiro
Hirata, Akihiro
Chohno, Teruhiro
Sasaki, Hirofumi
Horio, Yuki
Nakamura, Shiro
Association between serum tumor necrosis factor-alpha level and the efficacy of infliximab for refractory pouchitis after restorative proctocolectomy in patients with ulcerative colitis
title Association between serum tumor necrosis factor-alpha level and the efficacy of infliximab for refractory pouchitis after restorative proctocolectomy in patients with ulcerative colitis
title_full Association between serum tumor necrosis factor-alpha level and the efficacy of infliximab for refractory pouchitis after restorative proctocolectomy in patients with ulcerative colitis
title_fullStr Association between serum tumor necrosis factor-alpha level and the efficacy of infliximab for refractory pouchitis after restorative proctocolectomy in patients with ulcerative colitis
title_full_unstemmed Association between serum tumor necrosis factor-alpha level and the efficacy of infliximab for refractory pouchitis after restorative proctocolectomy in patients with ulcerative colitis
title_short Association between serum tumor necrosis factor-alpha level and the efficacy of infliximab for refractory pouchitis after restorative proctocolectomy in patients with ulcerative colitis
title_sort association between serum tumor necrosis factor-alpha level and the efficacy of infliximab for refractory pouchitis after restorative proctocolectomy in patients with ulcerative colitis
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768686/
https://www.ncbi.nlm.nih.gov/pubmed/31583309
http://dx.doi.org/10.23922/jarc.2016-008
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