TITLE

AZATHIOPRINE AND SMOKING STATUS IN CROHN'S DISEASE PREDICT RESPONSE TO INFLIXIMAB

AUTHOR(S)
Arnott, I.D.R.; Satsangi, J.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA13
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: Up to 75% of patients given infliximab for Crohn's disease (CD) will respond. A number of clinical parameters that may predict response have been proposed but none has been reproduced in an independent cohort. We aimed to identify clinical and laboratory markers of response in patients receiving infliximab at our institution. Methods: Seventy four well characterised CD patients (42 females, median age 34 years (IQR 23-42.5)) were assessed. Full clinical data were collected prospectively and blood was taken for inflammatory markers, ASCA and ANCA. Eleven had ileal disease, 25 colonic disease, 28 ileocolonic disease and 10 had recurrence following ilesotomy. Sixteen had received azathioprine for > 3 months and 5 methotrexate. Single infusion infliximab (5 mg/kg) was given for luminal disease (60 patients) and 3 infusions for fistulating disease (14 patients). Disease activity was assessed by the Harvey-Bradshaw index and a response was defined as a reduction of four or more points or a 50% reduction in draining fistula. Results: Those who smoked greater that 5 cigarettes per day for > 6 months were less likely to respond to infliximab than those who did not (11/21 v 39/47, Χ² = 7.0, p = 0.008, OR 0.22 (CI 0.08 to 0.41)). Patients on azathioprine for longer that three months at infusion were more likely to respond (15/16 v 35/52, Χ² = 4.4, p = 0.036, OR 7.31 (CI 3.34 to 10.31)). There was a trend towards better response rates in those with colonic disease (Χ² = 2.7, p = 0.09) and worse response rates in those with perianal disease (Χ²=3.7, p = 0.056). Age at diagnosis, previous surgery, sex, pre-infusion disease activity, CRP, and ASCA/ANCA status did not influence response rates in our cohort. Conclusion: Smoking has a strong adverse effect on response rates to infliximab. Furthermore, patients established on azathioprine for greater than 3 months had greater response rates. Every effort should be made to...
ACCESSION #
9747339

 

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