Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Jun 16;9(6):e99293.
doi: 10.1371/journal.pone.0099293. eCollection 2014.

Rate and predictors of mucosal healing in patients with inflammatory bowel disease treated with anti-TNF-alpha antibodies

Florian Beigel  1 , Matthias Deml  1 , Fabian Schnitzler  1 , Simone Breiteneicher  1 , Burkhard Göke  1 , Thomas Ochsenkühn  2 , Stephan Brand  1
Affiliations
Comparative Study

Rate and predictors of mucosal healing in patients with inflammatory bowel disease treated with anti-TNF-alpha antibodies

Florian Beigel et al. PLoS One. .

Abstract

Objective: Mucosal healing (MH) is an important treatment goal in patients with inflammatory bowel disease (IBD), but factors predicting MH under medical therapy are largely unknown. In this study, we aimed to characterize predictive factors for MH in anti-TNF-alpha antibody-treated IBD patients.

Methods: We retrospectively analyzed 248 IBD patients (61.3% CD, 38.7% UC) treated with anti-TNF-alpha antibodies (infliximab and/or adalimumab) for MH, defined as macroscopic absence of inflammatory lesions (Mayo endoscopy score 0 or SES-CD score 0) in colonoscopies which were analyzed before and after initiation of an anti-TNF-alpha antibody treatment.

Results: In patients treated with only one anti-TNF-alpha antibody ("TNF1 group", n = 202), 56 patients (27.7%) achieved complete MH at follow-up colonoscopy (median overall follow-up time: 63 months). In a second cohort (n = 46), which comprised patients who were consecutively treated with two anti-TNF-alpha antibodies ("TNF2 group"), 13 patients (28.3%) achieved complete MH (median overall follow-up time: 64.5 months). Compared to patients without MH, CRP values at follow-up colonoscopy were significantly lower in patients with MH (TNF1 group: p = 8.35×10-5; TNF2 group: p = 0.002). Multivariate analyses confirmed CRP at follow-up colonoscopy as predictor for MH in the TNF1 group (p = 0.012). Overall need for surgery was lower in patients with MH (TNF1 group: p = 0.01; TNF2 group: p = 0.03).

Conclusions: We identified low serum CRP level at follow-up colonoscopy as predictor for MH, while MH was an excellent negative predictor for the need for surgery.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: F. Beigel, F. Schnitzler, T. Ochsenkühn and S. Brand received lecture fees, travel support and financial support for research from: Abbott, MSD. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Study design.
Data of 802 patients were available for analysis (75.3% patients with Crohn's disease and 24.7% patients with ulcerative colitis). In 554 IBD patients, there was no baseline and/or follow-up colonoscopy available. Accordingly, 248 patients were included in the analysis, while 202 patients were treated with one anti-TNF antibody between baseline and follow-up colonoscopy (TNF1 group) and 46 patients were treated with a second anti-TNF antibody after loss of response or intolerance to a first anti-TNF antibody (TNF2 group).
Figure 2
Figure 2. Rates of mucosal healing in both groups.
In the TNF1 group, 146 patients (72.3%) had no MH, while 56 patients (27.7%) had MH. In the TNF2 group, 13 patients (28.6%) patients had MH, while 33 patients (71.4%) had no MH at follow-up colonoscopy.
Figure 3
Figure 3. CRP values at follow-up colonoscopy (TNF1 group).
At follow-up colonoscopy, CRP values were significantly lower in patients with MH compared to patients without MH (*p = 8.34E-05).
Figure 4
Figure 4. CRP values at follow-up colonoscopy (TNF2 group).
At follow-up colonoscopy, there was a trend for lower CRP in patients with MH compared to patients without MH (*p = 0.002).
Figure 5
Figure 5. Kaplan-Mayer estimate for surgery-free time intervals in the TNF1 group over the follow-up time.
During the follow-up time, 3 patients with MH underwent surgery as compared to 31 patients without MH patients (logrank p = 0.01).
Figure 6
Figure 6. Kaplan-Mayer estimate for surgery-free time intervals in the TNF2 group over the follow-up time.
During the follow-up time, no patient with MH underwent surgery as compared to 10 patients without MH (logrank p = 0.03).
See this image and copyright information in PMC

References

    1. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A (2011) Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 140: 1785–1794. - PubMed
    1. Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, et al. (2002) Long-term evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis 8: 244–250. - PubMed
    1. Schroeder KW, Tremaine WJ, Ilstrup DM (1987) Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 317: 1625–1629. - PubMed
    1. Matts SG (1961) The value of rectal biopsy in the diagnosis of ulcerative colitis. Q J Med 30: 393–407. - PubMed
    1. Lichtiger S, Present DH, Kornbluth A, Gelernt I, Bauer J, et al. (1994) Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 330: 1841–1845. - PubMed

Publication types

MeSH terms