An analysis of factors influencing short-term and sustained response to infliximab treatment for Crohn's disease
An analysis of factors influencing short-term and sustained response to infliximab treatment for Crohn's disease
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DOI：
10.1046/j.1365-2036.2003.01574.x
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发表时间：
2003-06-15
影响因子：
7.6
通讯作者：
Satsangi, J
中科院分区：
文献类型：
--
作者：
Arnott, IDR;McNeill, G;Satsangi, J
背景：接受英夫利西单抗治疗克罗恩病的患者中，59-81%有反应。虽然现在被广泛使用，但关于病人护理的最佳位置几乎没有共识。最近开发的指南已经确定需要标记物，预测respons.Aims：我们的目的是确定标记物的反应，以英夫利昔单抗给予克罗恩病。方法：标记物的反应（定义在4周）进行了前瞻性评估，在74英夫利昔单抗治疗的克罗恩病患者。结果：74例患者中有54例（73%）有反应。单变量分析表明，吸烟者比非吸烟者更不可能有反应[P = 0.005，比值比（OR）0.22]。接受免疫抑制治疗的患者（P = 0.034，OR 7.31）和孤立性结肠疾病患者（P = 0.042，OR 3.83）更有可能应答。多元Logistic回归证实吸烟（P = 0.035，OR 0.24）和结肠疾病（P = 0.035，OR 4.87）是反应的独立标志物。吸烟者和非吸烟者的一年复发率有显著差异（100% vs. 39.6%，P = 0.0026，相对风险3.2）和接受免疫调节剂或未接受免疫调节剂治疗的患者之间（58.0%vs.92.8%，P = 0.0054，相对危险度2.6）。吸烟对英夫利西单抗的应答率和应答维持有很强的不良影响。接受免疫调节剂治疗的患者具有更有利的短期和长期缓解。这些结果对临床实践具有重要意义。
Background: 59-81% of patients given infliximab for Crohn's disease will respond. Although now in widespread use, little consensus exists regarding the optimal place in patient care. Recently developed guidelines have identified need for markers that predict response.Aims: We aimed to identify markers of response to infliximab given for Crohn's disease.Methods: Markers of response (defined at 4 weeks) were prospectively assessed in 74 infliximab-treated patients with Crohn's disease. Patients were followed-up to 1 year.Results: Fifty-four of 74 (73%) patients responded. Univariate analysis identified that smokers were less likely to respond than non-smokers [P = 0.005, odds ratio (OR) 0.22]. Patients established on immunosuppression (P = 0.034, OR 7.31) and with isolated colonic disease (P = 0.042, OR 3.83) were more likely to respond. Multiple logistic regression confirmed smoking (P = 0.035, OR 0.24) and colonic disease (P = 0.035, OR 4.87) as independent markers of response. One-year relapse rates differed significantly between smokers and non-smokers (100% vs. 39.6%, P = 0.0026, relative risk 3.2) and between patients established on immunomodulators or not (58.0% vs. 92.8%, P = 0.0054, relative risk 2.6).Conclusions: Smoking has a strong adverse effect on the response rates and maintenance of response to infliximab. Patients on immunomodulators have a more favourable short- and long-term response. These results have important implications for clinical practice.