[en] BACKGROUND & AIMS: Infliximab is an antibody against tumor necrosis factor-alpha that is used to treat patients with moderate to severe Crohn's disease (CD). C-reactive protein (CRP) is a marker used to identify and follow individuals with CD. We analyzed changes in levels of CRP in a large cohort of patients with CD undergoing treatment with infliximab. METHODS: Serial levels of CRP were analyzed in 718 CD patients. Blood was collected before each infusion; a total of 8845 CRP levels were available for analysis. The correlations between CRP levels and need for dose adjustment, outcomes, and mucosal healing (based on endoscopic analysis of 253 patients) were evaluated. Therapy adjustment was considered successful if therapy continued without need for change. Subgroup analysis was performed by using data from 268 patients who received 8 weeks of maintenance therapy. RESULTS: More patients with high baseline levels of CRP responded to infliximab than patients with normal levels (90.8% vs 82.6%; P = .014). Early normalization of CRP levels correlated with sustained long-term response (P < .001). CRP levels remained significantly higher among patients who lost their response to infliximab, compared with those with a sustained response (P = .001). At time of loss of response, CRP levels were significantly increased (median, 11.2 mg/L) and did not return to baseline levels (median, 18.2 mg/L; P = .039). CRP correlated with mucosal healing (P = .033). CONCLUSIONS: CRP is a good marker of disease activity in patients treated with infliximab. Increased levels of CRP indicate mucosal inflammation and a likelihood of clinical relapse.
Crohn, B.B., Ginzburg, L., Oppenheimer, G.D., Regional ileitis: a pathologic and clinical entity (1932) JAMA, 99, pp. 1323-1329
Baumgart, D.C., Sandborn, W.J., Inflammatory bowel disease: clinical aspects and established and evolving therapies (2007) Lancet, 12, pp. 1641-1657
Xavier, R.J., Podolsky, D.K., Unravelling the pathogenesis of inflammatory bowel disease (2007) Nature, 448, pp. 427-434
Podolsky, D.K., Inflammatory bowel disease (2002) N Engl J Med, 347, pp. 417-429
Stokkers, P.C., Camoglio, L., van Deventer, S.J., Tumor necrosis factor (TNF) in inflammatory bowel disease: gene polymorphisms, animal models, and potential for anti-TNF therapy (1995) J Inflamm, 47, pp. 97-103. , 2013
Martinez-Montiel, M.P., Munoz-Yagüe, M.T., Biologic therapies for chronic inflammatory bowel disease (2006) Rev Esp Enferm Dig, 98, pp. 265-291
Present, D.H., Rutgeerts, P., Targan, S., Infliximab for the treatment of fistulas in patients with Crohn's disease (1999) N Engl J Med, 340, pp. 1398-1405
Rutgeerts, P., D'Haens, G., Targan, S., Efficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn's disease (1999) Gastroenterology, 117, pp. 761-769
Hanauer, S.B., Feagan, B.G., Lichtenstein, G.R., Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial (2002) Lancet, 359, pp. 1541-1549
Sands, B.E., Blank, M.A., Patel, K., Long-term treatment of rectovaginal fistulas in Crohn's disease: response to infliximab in the ACCENT II Study (2004) Clin Gastroenterol Hepatol, 2, pp. 912-920
Rutgeerts, P., Vermeire, S., Van Assche, G., Biological therapy for inflammatory bowel diseases (2009) Gastroenterology, 136, pp. 1182-1197
Peyrin-Biroulet, L., Deltenre, P., De Suray, N., Efficacy and safety of tumor necrosis factor antagonists in Crohn's disease: meta-analysis of placebo controlled trials (2008) Clin Gastroenterol Hepatol, 6, pp. 644-653
Kuhner, I., C-reactive protein and the acute-phase response (1990) Hosp Pract, 25, p. 13. , 16, 21-28
Tall, A.R., C-reactive protein reassessed (2004) N Engl J Med, 350, pp. 1450-1452
Vermeire, S., Van Assche, G., Rutgeerts, P., Laboratory markers in IBD: useful, magic, or unnecessary toys? (2006) Gut, 55, pp. 426-431
Vermeire, S., Van Assche, G., Rutgeerts, P., The role of C-reactive protein as an inflammatory marker in gastrointestinal dsieases (2005) Nat Clin Pract Gastroenterol Hepatol, 2, pp. 580-586
Schnitzler, F., Fidder, H., Ferrante, M., Long-term outcome of treatment with infliximab in 614 patients with Crohn's disease: results from a single-centre cohort (2009) Gut, 58, pp. 492-500
Schnitzler, F., Fidder, H., Ferrante, M., Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn's disease (2009) Inflamm Bowel Dis, 15, pp. 1295-1301
Colombel, J.F., Sandborn, W.J., Reinisch, W., Infliximab, azathioprine, or combination therapy for Crohn's disease (2010) N Engl J Med, 362, pp. 1383-1395
Fidder, H., Schnitzler, F., Ferrante, M., Long-term safety of infliximab for the treatment of inflammatory bowel disease: a single-centre cohort study (2009) Gut, 58, pp. 477-478
Ferrante, M., Vermeire, S., Katsanos, K.H., Predictors of early response to infliximab in patients with ulcerative colitis (2007) Inflamm Bowel Dis, 13, pp. 123-128
Van Assche, G., Vermeire, S., Rutgeerts, P., Mucosal healing and anti TNFs in IBD (2010) Curr Drug Targets, 11, pp. 227-233
Denis, M.A., Reenaers, C., Fontaine, F., Assessment of endoscopic activity and biological inflammatory markers in clinically active Crohn's disease with normal C-reactive protein serum level (2007) Inflamm Bowel Dis, 13, p. 11
