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Journal of Crohn's and Colitis: 9 (5)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium

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High C-reactive protein in Crohn's disease patients predicts nonresponse to infliximab treatment

Fernando Magro , Eduardo Rodrigues-Pinto , João Santos-Antunes , Filipe Vilas-Boas , Susana Lopes , Amadeu Nunes , Claudia Camila-Dias , Guilherme Macedo
DOI: http://dx.doi.org/10.1016/j.crohns.2013.07.005 129-136 First published online: 1 February 2014

Abstract

Background Infliximab (IFX) is effective in treating Crohn's disease (CD) and C-reactive protein (CRP) is a useful biomarker in assessing inflammatory activity.

Aim Correlate CRP levels before beginning of IFX, at week 14 and CRP delta within the first year of IFX treatment.

Methods Retrospective study of CD patients undergoing treatment with IFX. Primary nonresponse (PNR) was defined as no symptomatic improvement and CRP persistently elevated; sustained response (SR) as symptomatic improvement for at least 1 year without therapeutic adjustment; response after therapeutic adjustment (RTA) as analytic and clinical response but requiring IFX dose/frequency adjustment or association with another drug.

Results Baseline CRP levels were higher in PNR compared with SR (26.2 mg/L vs 9.6 mg/L, p = 0.015) and RTA (26.2 mg/L vs 7.6 mg/L, p = 0.007). CRP levels greater than 15 mg/L at baseline predict PNR with 67% sensitivity and 65% specificity. Lower CRP levels at week 14 were more likely to predict SR relative to RTA (3.1 mg/L vs 7.6 mg/L p = 0.019) and PNR (3.1 mg/L vs 9.1 mg/L; p = 0.013). CRP levels greater than 4.6 mg/L at week 14 predict PNR with 67% sensitivity and 62% specificity. A higher CRP delta between beginning of treatment and week 14 is more likely to predict SR relative to RTA (5.2 mg/L vs 0.6 mg/L p = 0.027).

Conclusion CRP levels at week 14 were associated with SR in patients treated with IFX, independently of baseline CRP serum levels. High inflammatory burden at beginning of IFX treatment was correlated with a worse response.

Keywords
  • Crohn disease
  • Infliximab
  • C-reactive protein
  • Prognosis
  • Treatment outcome
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