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-TNF therapy. 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 on immunosuppressive therapy plus anti TNFa agents. Results: It was observed that all patients with CD had significantly decreased FC levels after anti TNFa therapy (963.97 mg/kg initially vs. 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 ASCA IgA/IgG were 17/24 tested patients, but no differences 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 for patients with CD in anti TNF therapy, whereas others such as ANA and ASCA were not useful to monitor the therapy.