Transmural remission characterized by high biologic concentrations demonstrates better prognosis in Crohn's disease
Transmural remission characterized by high biologic concentrations demonstrates better prognosis in Crohn's disease
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以高生物浓度为特征的透壁缓解表明克罗恩病的预后更好
DOI：
10.1093/ecco-jcc/jjac185
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Ryuichi Okamoto
中科院分区：
文献类型：
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作者：
Kento Takenaka;Ami Kawamoto;Yoshio Kitazume;Toshimitsu Fujii;Yumi Udagawa;Hiromichi Shimizu;Shuji Hibiya;Masakazu Nagahori;Kazuo Ohtsuka;Mamoru Watanabe;Ryuichi Okamoto
克罗恩病（CD）患者透壁愈合的重要性和病理生理学仍有待证实。我们的目的是研究血清浓度的生物制剂和透壁缓解评估通过磁共振肠造影[MRE].MethodsWe招募患者CD谁收到维护生物制剂1年后诱导和前瞻性随访至少1年后，基线实验室，内镜和MRE检查。我们评估了基线因素之间的关系，包括存在透壁缓解和患者的预后，以及血清浓度和transmarticalremission.ResultsWe包括134例患者，其中65，31，27和11接受英夫利昔单抗，阿达木单抗，优特克单抗和Vedolizumab，分别。达到透壁缓解的患者比未达到缓解的患者住院和手术的风险低[p<0.01]。 透壁缓解预测住院和手术的校正危险比分别为0.11和0.02，低于临床缓解、生化缓解和内镜缓解。关于血清浓度，所有药物的透壁缓解患者的中位浓度均高于透壁活性患者[英夫利昔单抗p< 0.01，阿达木单抗p= 0.04，优特克单抗p< 0.01，Vedolizumab p= 0.08]。 高药物浓度水平与经MRE证实的透壁缓解相关。
BackgroundThe importance and pathophysiology of transmural healing in patients with Crohn’s disease [CD] remains to be verified. We aimed to examine the association between serum concentrations of biologics and transmural remission evaluated via magnetic resonance enterography [MRE].MethodsWe enrolled patients with CD who received maintenance biologics 1 year after induction and prospectively followed up for at least 1 year after baseline laboratory, endoscopic and MRE examination. We evaluated the relationship between baseline factors including the presence of transmural remission and patient prognosis, as well as between serum concentrations and transmural remission.ResultsWe included 134 patients, of whom 65, 31, 27 and 11 received infliximab, adalimumab, ustekinumab and vedolizumab, respectively. Those who achieved transmural remission showed a lower risk of hospitalization and surgery than those who did not achieve remission [p< 0.01]. Adjusted hazard ratios of transmural remission for predicting hospitalization and surgery were 0.11 and 0.02, respectively, which were lower than those of clinical remission, biochemical remission and endoscopic remission. Regarding serum concentrations, the median concentration was higher in patients with transmural remission than in patients with transmural activity for all agents [p< 0.01 for infliximab,p= 0.04 for adalimumab,p< 0.01 for ustekinumab,p= 0.08 for vedolizumab].ConclusionsTransmural remission was the best predictor for prognosis in CD patients who received maintenance biologic therapy. High drug concentration levels were associated with transmural remission confirmed via MRE.