Serum PR3-ANCA Is a Predictor of Primary Nonresponse to Anti-TNF-α Agents in Patients with Ulcerative Colitis

Atsushi Yoshida; Katsuyoshi Matsuoka; Fumiaki Ueno; Toshio Morizane; Yutaka Endo; Toshifumi Hibi

doi:10.1159/000515361

Serum PR3-ANCA Is a Predictor of Primary Nonresponse to Anti-TNF-α Agents in Patients with Ulcerative Colitis

Inflamm Intest Dis. 2021 May;6(2):117-122. doi: 10.1159/000515361. Epub 2021 Apr 13.

Authors

Atsushi Yoshida¹, Katsuyoshi Matsuoka², Fumiaki Ueno¹, Toshio Morizane¹, Yutaka Endo¹, Toshifumi Hibi³

Affiliations

¹ Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan.
² Department of Gastroenterology and Hepatology, Toho University Sakura Medical Center, Chiba, Japan.
³ Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan.

Abstract

Background: Anti-tumor necrosis factor-α (TNF-α) agents are effective for moderately to severely active ulcerative colitis (UC). Nonetheless, a proportion of patients fail to respond to these agents as therapy for induction of remission. Recent studies indicated that perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) may predict response to anti-TNF-α agents in UC patients. However, whether PR3-ANCA can predict primary nonresponse (PNR) to anti-TNF-α agents has not yet been evaluated. The aim of this study was to examine whether PR3-ANCA can predict PNR to anti-TNF-α in UC patients.

Methods: This was a single-center retrospective study. Data were extracted from 50 patients with UC who had measurements of PR3-ANCA and received anti-TNF-α agents for the first time as induction therapy. The primary endpoint of this study was a proportion of patients with PNR stratified by PR3-ANCA positivity. PNR to anti-TNF-α agents was defined as failure to achieve reduction in partial Mayo score by 2 or more points and change to other therapeutics within 6 weeks.

Results: Fourteen (28%) of the 50 patients were PR3-ANCA positive. Seventeen (34%) of the 50 patients demonstrated PNR. Eleven (78.6%) of the 14 PR3-ANCA-positive patients demonstrated PNR, while 6 (16.7%) of the 36 PR3-ANCA-negative patients demonstrated PNR. Multivariate analysis demonstrated that PR3-ANCA positivity was associated with PNR to anti-TNF-α agents (odds ratio 19.29, 95% CI: 3.30-172.67; p = 0.002).

Conclusion: PR3-ANCA positivity can predict PNR to anti-TNF-α agents in UC patients.

Keywords: Adalimumab; Golimumab; Inflammatory bowel disease; Infliximab; Primary failure.