Predictive factors for primary nonresponse to biologics in ulcerative colitis: a prospective multicenter study

Area of Science:

• Gastroenterology
• Immunology
• Clinical Medicine

Background:

• Ulcerative colitis (UC) treatment involves biologic agents.
• Predicting treatment response is crucial for personalized therapy.
• Primary nonresponse (PNR) to biologics impacts patient outcomes.

Purpose of the Study:

• Evaluate protease-3 (PR3)-anti-neutrophil cytoplasmic antibodies (ANCAs) and myeloperoxidase (MPO)-ANCA for predicting PNR to biologics in UC.
• Identify predictors for PNR to anti-TNF and anti-integrin therapies.

Main Methods:

• Prospective multicenter cohort study of biologic-naïve UC patients.
• Patients received anti-TNF, anti-integrin, or anti-IL12/23 agents as first-line therapy.
• PNR defined by insufficient symptom improvement or treatment modification; logistic regression used for analysis.

Main Results:

• PR3-ANCA positivity was common in anti-TNF recipients (47.4%).
• PR3-ANCA-positive patients on anti-TNF therapy had significantly higher PNR rates (66.7% vs 25.0%, P=0.02).
• PR3-ANCA independently predicted PNR to anti-TNF therapy (OR 5.61). Platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammatory index (SII) predicted PNR to anti-integrin therapy.

Conclusions:

• PR3-ANCA predicts PNR to anti-TNF therapy in UC.
• PR3-ANCA does not predict PNR to anti-integrin therapy; PLR and SII are potential predictors.
• PR3-ANCA can inform biologic selection for personalized UC treatment.