| Background and AimsCrohn’s disease(CD)is a chronic,relapsing,non-specific disease which occurs mainly in the intestines.Though crohn’s disease is common in developed countries,epidemiological studies have found that the incidence of Crohn’s disease in Eastern Europe and Asia are increasing in recent years.The disease is chronically as well as recurrently which lead to high disability rate,and most of whom are youth or middle-aged,therefore,lowering the patient’s life quality and the social productivity.Infliximab which has been widely used to treat crohn’s disease is the most significant medincie in the clinical process.With the increasing incidence of Crohn’s disease in China,the demand for infliximab in patients with Crohn’s disease has been increased significantly.Infliximab is a monoclonal hybrid antibody which contains 75%human antibody and 25%murine antibody that can neutralize TNF-a to induce intestinal inflammation relief.Due to contain of murine,some patients have developed antibody to infliximab(ATI).ATI is an anti-drug antibody produced by patients underwent infliximab.However,it is still unclear about ATI and the combination treatment and prognosis of patients with Crohn’s disease.At present,some studies suggested that ATI may reduce trough level of infliximab(TLI)by accelerating accelerate the metabolism of infliximab.Some studies suggested that ATI can reduce the therapeutic effect by neutralizing infliximab which lead to clinically unresponsiveness to infliximab,prolonging or causing long-term failure to achieve clinical remission in patients with Crohn’s disease.There are also studies suggesting that ATI has no significant effect on patients with Crohn’s disease who receive infliximab.At the moment,the effects of ATI treatment on those patients are still unclear.The effect of ATI on the body and its significance on intestinal mucosal healing,inducing of ATI reduction.There was also a slight study of follow-up about this study which was to evaluate the effect of ATI on patients with Crohn’s disease underwent infliximab,and to understand the effect of ATI on the infliximab and the effects of clinical symptoms and intestinal remission and its relationship with drug therapy.MethodsWe conducted a retrospective study of patients with crohn’s disease who received infliximab(5 mg/kg)at Nanfang Hospital,Southern Medical University.Patients underwent azathioprine and infliximab were put in combination group and patients underwent infliximab were put in monotherapy group.At 14 weeks,patients were exam TLI and ATI and TNF-alpha.The patient adjusted the treatment regimen after 6 time of infusion of infliximab,receiving IFX,azathioprine,or both of them to maintain disease.The patient underwent colonoscopy within 30 weeks of treatment to assessed status of intestinal mucosal healing,and assessed the condition of clinical symptoms,CDAI,and SES-CD.Results1)Patient enrollment:78 patients with CD were enrolled and divided into 2 groups:combined group(n = 38)and monotherapy group(n = 40).The rate of ATI>0 ng/ml in combination group was 2.6%,and the monotherapy group was 25.0%and total rate of ATI>0 ng/ml was 14.5%.2)ATI examination:The mean titer ATI of the combined group was 3.39 ±19.33 ng/ml,and the monotherapy group was 8.95± 17.95 ng/ml(p =0.134)。3)TLI examination:The trough level of infliximab in the combination group was higher than that in the monotherapy group(5.90 vs 3.21 ug/ml,p = 0.016).4)Mucosal healing:No difference was found in combined group and monotherapy group in the degree of mucosal remission within 30 weeks(p = 0.237)5)CDAI evalution:The combined group had lower clinical activity than the monotherapy group in 14 weeks(p = 0.044)and 30 weeks(p = 0.048).Conclusion1.Azathioprine helps to reduce the risk of formation of ATI and reduce titer of ATI.2.Azathioprine helps to maintain higher trough level of infliximab.3.Combination therapy of infliximab and zathioprine can reduce clinical activity of crohn’s disease.4.ATI is associated with lower trough levels of infliximab.5.IFX mono therapy or combination therapy have no significant influence on TNF-a on patients with crohn’s disease. |
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