IBD Watch®
Timely Information for Practicing Physicians
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OCTOBER 2002CROHN'S DISEASE (CD) Predictors of response to infliximab. Mansour Parsi and colleagues evaluated 100 patients with inflammatory (n=59) or fistulous (n=41) CD who had at least 3 months of follow-up after infliximab infusion. Overall, 67% of patients responded to infliximab therapy. For those with inflammatory disease, the response rates for nonsmokers compared to smokers (73% vs. 22%) and for those receiving immunosuppressives compared to those not given immunosuppressives (74% vs. 39%) were greater (p<0.001 and p=0.007, respectively). Prolonged response duration (>2 months) was achieved in 59% of nonsmokers vs. 6% of smokers (p<0.001) and in 65% of patients on immunosuppressives vs. 18% of those not on immunosuppressives (p<0.001). These differences in response rates were not observed for patients with fistulous disease. However, nonsmokers with fistulous disease had a longer duration of response (p=0.046). This analysis identified nonsmoking and immunosuppressive therapy as factors predictive for high response rates to infliximab treatment for patients with inflammatory CD. In patients with fistulous CD, nonsmoking was associated with longer duration of response to infliximab. (Parsi MH, et al. Gastroenterology 2002;123:707-713) Effect of infliximab on resource use. J.H. Rubenstein and associates reviewed medical records from all CD patients (n=79) seen at University of Chicago Hospitals to obtain resource-use information for at least 1 year prior to and 1 year following initial infliximab infusion therapy. The use of infliximab was associated with decreases in the annual incidences of several procedures including: all surgeries (30%, p<0.01); gastrointestinal surgeries (18%, p<0.05); endoscopies (43%, p<0.01); emergency room visits (66%, p<0.05); outpatient visits (16%, p<0.05); and radiologic examinations (12%, p<0.05). Fistula patients (n=37) also realized decreases in hospitalizations (59%, p<0.05). This retrospective review shows that infliximab therapy of CD patients is associated with decreases in resource use that may potentially offset its cost. (Rubenstein RH, et al. J Clin Gastroenterol 2002;35:151-156) Ineffectiveness of probiotics. C. Prantera et al. conducted a study in which 45 CD patients who had undergone surgical resection were randomized to receive a Lactobacillus probiotic or a placebo for 1 year. CD recurred clinically in 3 patients in the Lactobacillus treatment group and 2 patients in the placebo group; 9 of 15 evaluable Lactobacillus-treated patients (60%) and 6 of 17 evaluable placebo patients (35%) had endoscopic recurrence (p=0.297). Thus, 1 year of probiotic therapy with Lactobacillus was not observed to prevent endoscopic recurrence of CD or to reduce the severity of recurrent lesions. (Prantera C, et al. Gut 2002; 51:405-409) CD-associated immune responses to auto- and microbial antigens. Carol Landers and colleagues analyzed sera (IgA and IgG ELISAs) from 330 patients with CD for E. coli outer-membrane porin C, Pseudomonas fluorescens-associated sequence 12, antisaccharomyces cerevisiae (ASCA), and perinuclear antineutrophil cytoplasmic (ANCA) antibodies. They found that 85% of patients responded to at least 1 antigen, however only 4% of patients responded to all 4 antigens. Twenty-six percent of patients reacted to all 3 microbial antigens and 23% reacted to the auto-antigen (ANCA-positive). Cluster analysis yielded 4 groups of patients: 1) ASCA-positive; 2) outer membrane C/12-positive; 3) perinuclear ANCA-positive; and 4) no (or low) response. These data demonstrated that serum immune responses to microbial and auto-antigens are not uniform among CD patients, suggesting individual susceptibility to specific enteric flora. These results are consistent with animal models where model-specific flora are associated with intestinal inflammation. (Landers CJ, et al. Gastroenterology 2002;123:689-699) INFLAMMATORY BOWEL DISEASE (IBD) Uveitis and erythema nodosum (EN) in IBD. Timothy Orchard et al. reviewed the case notes of 1,459 patients with IBD (976 patients with UC and 483 patients with CD) and identified 39 patients with EN and 50 patients with ocular inflammation. EN and ocular inflammation were associated with female gender, IBD relapse, and arthritis. Sequence-specific PCR typing for polymorphisms in HLA-B, DR, and TNF-a was performed in the 39 patients with EN and 40 patients with ocular inflammation and results were compared with 490 IBD patients without extra-intestinal manifestations, 69 patients with peripheral arthritis and 16 patients with ankylosing spondylitis. A strong association was observed between EN and -1031TNF-a and ocular inflammation was associated with HLA-B*27, B*58, and HLA-DRB1*0103. These findings indicate that EN, uveitis, and arthritis commonly occur together in IBD patients and are associated with genes in the HLA region. (Orchard TR, et al. Gastroenterology 2002;123:714-718) IBD in children £5 years of age. P. Mamula and colleagues reviewed the records of children diagnosed with IBD between 1977 and 2000 at The Children's Hospital of Philadelphia. Eighty-two children aged 5 years or younger were identified (35 children with CD, 30 children with UC, and 17 children with indeterminate colitis [IC]). Of these, 89% had large bowel disease and 34% had perianal disease. Linear growth failure occurred in 17% of all patients, and failure to thrive was seen in 44% of CD patients and 39% of IC patients. None were ASCA-positive and only 10 patients tested positively for perinuclear ANCA. This retrospective review revealed that in young patients with IBD: Colonic and perianal disease are common; the presence of failure to thrive indicates a diagnosis of CD or IC; and the standard IBD serology panel is of limited diagnostic value. (Mamula P, et al. Am J Gastroenterol 2002;97:2005-2010) |
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