Predictive value of mucosal TNF‐α transcripts in steroid‐refractory Crohn's disease patients receiving intensive immunosuppressive therapy

摘要: Background: Concentrations of proinflammatory cytokines are increased in the intestinal mucosa patients with active Crohn's disease (CD). In a prospective study we investigated whether can predict long-term remission (>6 months) steroid-refractory CD receiving treatment infliximab or cyclophosphamide, followed by azathioprine methotrexate. Methods: Cytokine transcripts were quantified using real-time polymerase chain reaction (PCR) mucosal biopsies from 19 active, before and 8 weeks after initiation therapy. Patients treated cyclophosphamide (monthly 750 mg intravenously) (5 mg/kg body weight) until relapse disease. Statistical analysis was performed to identify predictive factors discriminate between without remission. Results: Seventeen out achieved disease, two nonresponders, while six 17 exhibited an early recurrence. Pretreatment TNF-α, IL-18, MRP-14, IL-8 significantly correlated remission. While several cytokines, most importantly MMP-1, determined able achieving remission, only decrease TNF-α levels predictive. Overall, statistical identified lower pretreatment as strongest predictor among baseline variables. Conclusions: Quantification prior therapy allows identification upon immunosuppression cyclophosphamide. Real-time PCR might have considerable potential activity subsequent clinical management immunosuppressive therapies. (Inflamm Bowel Dis 2007;13:65–70)