PMID- 36926698 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231108 IS - 1598-9100 (Print) IS - 2288-1956 (Electronic) IS - 1598-9100 (Linking) VI - 21 IP - 4 DP - 2023 Oct TI - Serum albumin is the strongest predictor of anti-tumor necrosis factor nonresponse in inflammatory bowel disease in resource-constrained regions lacking therapeutic drug monitoring. PG - 460-470 LID - 10.5217/ir.2022.00128 [doi] AB - 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<0.001), postoperative recurrence (P=0.001) and high IL-7R expression (P<0.027) on univariate; and low albumin alone (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.03-0.28; P<0.001) on multivariate analysis respectively. Low albumin (HR, 0.31; 95% CI, 0.15-0.62; P=0.001) also predicted SLR. In UC, predictors of PNR were low albumin (P<0.001), and high C-reactive protein (P<0.001), OSM (P<0.04) and OSM-R (P=0.07) stromal expression on univariate; and low albumin alone (HR, 0.11; 95% CI, 0.03-0.39; P=0.001) on multivariate analysis respectively. CONCLUSIONS: Low serum albumin at baseline significantly predicted PNR in UC and PNR/SLR in CD patients. Mucosal markers of PNR were high stromal OSM/OSM-R in UC and high IL-7R in CD patients. FAU - Kumar, Peeyush AU - Kumar P AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Vuyyuru, Sudheer K AU - Vuyyuru SK AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Das, Prasenjit AU - Das P AD - Department of Pathology, All India Institute of Medical Sciences, New Delhi, India. FAU - Kante, Bhaskar AU - Kante B AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Ranjan, Mukesh Kumar AU - Ranjan MK AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Thomas, David Mathew AU - Thomas DM AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Mundhra, Sandeep AU - Mundhra S AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Sahu, Pabitra AU - Sahu P AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Venigalla, Pratap Mouli AU - Venigalla PM AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Jain, Saransh AU - Jain S AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Goyal, Sandeep AU - Goyal S AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Golla, Rithvik AU - Golla R AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Virmani, Shubi AU - Virmani S AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Singh, Mukesh K AU - Singh MK AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Sachdeva, Karan AU - Sachdeva K AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Sharma, Raju AU - Sharma R AD - Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India. FAU - Dash, Nihar Ranjan AU - Dash NR AD - Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India. FAU - Makharia, Govind AU - Makharia G AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Kedia, Saurabh AU - Kedia S AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. FAU - Ahuja, Vineet AU - Ahuja V AD - Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. LA - eng GR - 55/4/11/CARE-ID/2018-NCD/Indian Council for Medical Research/ PT - Journal Article DEP - 20230317 PL - Korea (South) TA - Intest Res JT - Intestinal research JID - 101572802 PMC - PMC10626021 OTO - NOTNLM OT - Albumins OT - Anti-tumor necrosis factor OT - Colitis, ulcerative OT - Crohn disease OT - Nonresponse COIS- Conflict of Interest No potential conflict of interest relevant to this article was reported. EDAT- 2023/03/18 06:00 MHDA- 2023/03/18 06:01 PMCR- 2023/10/01 CRDT- 2023/03/17 02:58 PHST- 2022/11/15 00:00 [received] PHST- 2023/01/09 00:00 [accepted] PHST- 2023/03/18 06:01 [medline] PHST- 2023/03/18 06:00 [pubmed] PHST- 2023/03/17 02:58 [entrez] PHST- 2023/10/01 00:00 [pmc-release] AID - ir.2022.00128 [pii] AID - ir-2022-00128 [pii] AID - 10.5217/ir.2022.00128 [doi] PST - ppublish SO - Intest Res. 2023 Oct;21(4):460-470. doi: 10.5217/ir.2022.00128. Epub 2023 Mar 17.