Dynamics of Some Routine Immunological Parameters During Anti - TNF Therapy in Patients with Crohn's Disease

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.

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.

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.

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.

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.