Effects of Tumor Necrosis Factor Antagonists in Patients With Primary Sclerosing Cholangitis.,Clinical Gastroenterology and Hepatology

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Effects of Tumor Necrosis Factor Antagonists in Patients With Primary Sclerosing Cholangitis.
Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2020-02-15 , DOI: 10.1016/j.cgh.2020.02.014
Charlotte Rose Hawkey Hedin ₁ , Gina Sado ₂ , Nelson Ndegwa ₃ , Ellina Lytvyak ₄ , Andrew Mason ₄ , Aldo Montano-Loza ₄ , Alessio Gerussi ₅ , Francesca Saffioti ₆ , Douglas Thorburn ₇ , Emma Nilsson ₈ , Geir Larsson ₉ , Bjørn A Moum ₉ , Kim N van Munster ₁₀ , Cyriel Y Ponsioen ₁₀ , Cynthia Levy ₁₁ , Nicholas F Nogueira ₁₂ , Christopher L Bowlus ₁₃ , Neta Gotlieb ₁₄ , Oren Shibolet ₁₄ , Kate D Lynch ₁₅ , Roger W Chapman ₁₅ , Christian Rupp ₁₆ , Mette Vesterhus ₁₇ , Kristin K Jørgensen ₁₈ , Fredrik Rorsman ₁₉ , Christoph Schramm ₂₀ , João Sabino ₂₁ , Severine Vermeire ₂₁ , Alessandra Zago ₂₂ , Nora Cazzagon ₂₂ , Hanns-Ulrich Marschall ₂₃ , Henriette Ytting ₂₄ , Karima Ben Belkacem ₂₅ , Olivier Chazouilleres ₂₅ , Sven Almer ₂ , , Annika Bergquist ₂

Affiliation

Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Division of Gastroenterology, Medical Unit Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; European Reference Network on Hepatological Diseases.
Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden; European Reference Network on Hepatological Diseases.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Katz Group Centre for Pharmacy and Health Research, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Sheila Sherlock Liver Center, Royal Free London National Health Service Foundation Trust, Institute for Liver and Digestive Health, University College of London, London, United Kingdom; Internal Medicine Unit, Department of Medicine, University of Udine, Udine, Italy; European Reference Network on Hepatological Diseases.
Sheila Sherlock Liver Center, Royal Free London National Health Service Foundation Trust, Institute for Liver and Digestive Health, University College of London, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; European Reference Network on Hepatological Diseases.
Sheila Sherlock Liver Center, Royal Free London National Health Service Foundation Trust, Institute for Liver and Digestive Health, University College of London, London, United Kingdom; European Reference Network on Hepatological Diseases.
Gastroenterology Clinic, Skåne University Hospital, Lund University, Lund, Sweden.
Dept. of Gastroenterology and Hepatology, Clinics of Medicine, Oslo University Hospital, Ullevål, Oslo, Norway; European Reference Network on Hepatological Diseases.
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands; European Reference Network on Hepatological Diseases.
Division of Hepatology, Miller School of Medicine, Miami, Florida.
Schiff Center for Liver Diseases, University of Miami, Miami, Florida.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, Sacramento, California.
Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.
Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway.
Department of Medical Sciences, Gastroenterology Research Group, University Hospital, Uppsala, Sweden.
Martin Zeitz Center for Rare Diseases, First Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases.
Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; European Reference Network on Hepatological Diseases.
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; European Reference Network on Hepatological Diseases.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University Hospital, Gothenburg, Sweden; European Reference Network on Hepatological Diseases.
Department of Medical Gastroenterology, Hvidovre Hospital, Department of Hepatology Rigshospitalet, Copenhagen, Denmark; European Reference Network on Hepatological Diseases.
Hepatology Department, French Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, French Network for Rare Liver Diseases in Adults and Children, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France; European Reference Network on Hepatological Diseases.

Background & Aims

Few patients with primary sclerosing cholangitis (PSC) and inflammatory bowel diseases (IBDs) are exposed to tumor necrosis factor (TNF) antagonists because of the often mild symptoms of IBD. We assessed the effects of anti-TNF agents on liver function in patients with PSC and IBD, and their efficacy in treatment of IBD.

Methods

We performed a retrospective analysis of 141 patients with PSC and IBD receiving treatment with anti-TNF agents (infliximab or adalimumab) at 20 sites (mostly tertiary-care centers) in Europe and North America. We collected data on the serum level of alkaline phosphatase (ALP). IBD response was defined as either endoscopic response or, if no endoscopic data were available, clinical response, as determined by the treating clinician or measurements of fecal calprotectin. Remission was defined more stringently as endoscopic mucosal healing. We used linear regression analysis to identify factors associated significantly with level of ALP during anti-TNF therapy.

Results

Anti-TNF treatment produced a response of IBD in 48% of patients and remission of IBD in 23%. There was no difference in PSC symptom frequency before or after drug exposure. The most common reasons for anti-TNF discontinuation were primary nonresponse of IBD (17%) and side effects (18%). At 3 months, infliximab-treated patients had a median reduction in serum level of ALP of 4% (interquartile range, reduction of 25% to increase of 19%) compared with a median 15% reduction in ALP in adalimumab-treated patients (interquartile range, reduction of 29% to reduction of 4%; P = .035). Factors associated with lower ALP were normal ALP at baseline (P < .01), treatment with adalimumab (P = .090), and treatment in Europe (P = .083).

Conclusions

In a retrospective analysis of 141 patients with PSC and IBD, anti-TNF agents were moderately effective and were not associated with exacerbation of PSC symptoms or specific side effects. Prospective studies are needed to investigate the association between use of adalimumab and reduced serum levels of ALP further.

中文翻译：

肿瘤坏死因子拮抗剂对原发性硬化性胆管炎患者的影响。

背景与目标

由于 IBD 的症状通常较轻，因此很少有原发性硬化性胆管炎 (PSC) 和炎症性肠病 (IBD) 患者暴露于肿瘤坏死因子 (TNF) 拮抗剂。我们评估了抗 TNF 药物对 PSC 和 IBD 患者肝功能的影响，以及它们在治疗 IBD 中的疗效。

方法

我们对在欧洲和北美 20 个地点（主要是三级医疗中心）接受抗 TNF 药物（英夫利昔单抗或阿达木单抗）治疗的 141 名 PSC 和 IBD 患者进行了回顾性分析。我们收集了血清碱性磷酸酶 (ALP) 水平的数据。IBD 反应被定义为内窥镜反应或临床反应，如果没有内窥镜数据可用，则由治疗临床医生或粪便钙卫蛋白的测量值确定。缓解被更严格地定义为内窥镜粘膜愈合。我们使用线性回归分析来确定与抗 TNF 治疗期间 ALP 水平显着相关的因素。

结果

抗 TNF 治疗在 48% 的患者中产生了 IBD 反应，在 23% 中产生了 IBD 缓解。在药物暴露之前或之后，PSC 症状频率没有差异。停用抗 TNF 的最常见原因是 IBD 的主要无反应 (17%) 和副作用 (18%)。在 3 个月时，英夫利昔单抗治疗患者的血清 ALP 水平中位降低 4%（四分位距，降低 25% 至增加 19%），而阿达木单抗治疗患者的 ALP 中位降低 15%（四分位间距）范围，减少 29% 到减少 4%；P = .035）。具有较低的ALP相关的因素在基线正常ALP（P <0.01）中，用阿达木单抗（治疗P = 0.090），以及治疗在欧洲（P = 0.083）。