Serum albumin is the strongest predictor of anti-tumor necrosis factor nonresponse in inflammatory bowel disease in resource-constrained regions lacking therapeutic drug monitoring

• Published in: Intestinal research 2023-10, Vol.21 (4), p.460-470
• Main Authors: Kumar, Peeyush, Vuyyuru, Sudheer K., Das, Prasenjit, Kante, Bhaskar, Ranjan, Mukesh Kumar, Thomas, David Mathew, Mundhra, Sandeep, Sahu, Pabitra, Venigalla, Pratap Mouli, Jain, Saransh, Goyal, Sandeep, Golla, Rithvik, Virmani, Shubi, Singh, Mukesh K., Sachdeva, Karan, Sharma, Raju, Dash, Nihar Ranjan, Makharia, Govind, Kedia, Saurabh, Ahuja, Vineet
• Format: Article
• Language: English
• Subjects: albumins; anti-tumor necrosis factor; colitis, ulcerative; crohn disease; nonresponse; Original
• ISSN: 1598-9100; 2288-1956
• DOI: 10.5217/ir.2022.00128

Background/Aims: Evidence on predictors of primary nonresponse (PNR), and secondary loss of response (SLR) to anti-tumor necrosis factor (anti-TNF) agents in inflammatory bowel disease is scarce from Asia. We evaluated clinical/biochemical/molecular markers of PNR/SLR in ulcerative colitis (UC) and Crohn’s disease (CD).Methods: Inflammatory bowel disease patients treated with anti-TNF agents (January 2005–October 2020) were ambispectively included. Data concerning clinical and biochemical predictors was retrieved from a prospectively maintained database. Immunohistochemistry for expression of oncostatin M (OSM), OSM receptor (OSM-R), and interleukin-7 receptor (IL-7R) were done on pre anti-TNF initiation mucosal biopsies.Results: One-hundred eighty-six patients (118 CD, 68 UC: mean age, 34.1±13.7 years; median disease duration at anti-TNF initiation, 60 months; interquartile range, 28–100.5 months) were included. PNR was seen in 17% and 26.5% and SLR in 47% and 28% CD and UC patients, respectively. In CD, predictors of PNR were low albumin (P