Dynamics of Some Routine Immunological Parameters During Anti - TNF Therapy in Patients with Crohn’s Disease

Abstract

Background: Fecal and immunological biomarkers can be used to diagnose and manage patients with Crohn’s disease (CD). Anti -tumor necrosis factor (TNF) should be evaluated in addition to biomarkers to determine the response to therapy.Objectives: The current study aimed at following up fecal calprotectin (FC), perinuclear anti - neutrophil cytoplasmic antibodies(pANCA), anti - Saccharomyces cerevisiae antibodies (ASCA), and anti - nuclear antibodies (ANA) in patients with CD on anti-TNFtherapy.Methods: A total of 57 patients with CD and the mean age of 40±15 years (ranged: 20 - 75) were monitored after initiation of anti- TNFa treatment. Stool samples were tested for FC (Alegria automated the enzyme - linked immunosorbent assay (ELISA) system),and serum samples for ANCA, ANA (indirect immunofluorescence - IIF), and ASCA (ELISA) in the beginning and after six months onimmunosuppressive therapy plus anti - TNFa agents.Results: Itwasobserved that all patients withCDhadsignificantly decreased FC levels after anti -TNFatherapy (963.97mg/kginitiallyvs. 268.42 mg/kg after treatment; P = 0.043). Moreover, in 75% of patients, FC levels dropped below the cutoff value of 50 mg/kg.Positive for ASCAIgA/IgG were 17/24 tested patients, butnodifferences were observed regarding the application of anti - TNFa therapy.However, the titers of pANCA decreased in four patients after anti - TNFa treatment. Conclusions: Initial and follow - up measurements of some immunological markers such as FC and pANCA could be of benefit forpatients with CD in anti - TNF therapy, whereas others such as ANA and ASCA were not useful to monitor the therapy.

Keywords

• tnfa inhibitors
• immunological biomarkers
• therapy monitoring