Journal Article

Neutrophil-to-Lymphocyte Ratio for Predicting Loss of Response to Infliximab in Ulcerative Colitis

Kamata, Noriko, Nishida, Yu, Tanaka, Fumio, Watanabe, Toshio, Yukawa, Tomomi, Hosomi, Shuhei, Shiba, Masatsugu, Nagami, Yasuaki, Yamagami, Hirokazu, Otani, Koji, Watanabe, Kenji, Tominaga, Kazunari, Tanigawa, Tetsuya, Fujiwara, Yasuhiro, Taira, Koichi

2017

Overview

Neutrophil-to-lymphocyte ratio (NLR) has been used to determine the outcome in malignancies and coronary heart disease. Some reports considered the value of NLR as a predictor of response to infliximab in patients with Crohn's disease or rheumatoid arthritis; however, no similar studies have been reported for ulcerative colitis (UC). This study aimed to evaluate the clinical significance of the baseline NLR in patients with UC treated by infliximab. Patients with moderate-to-severe active UC who received the first infliximab infusion in our hospital between 2010 and 2015, who showed clinical response during the induction period, were retrospectively evaluated for long-term outcomes and risk factors for loss of response (LOR) during infliximab maintenance therapy. Baseline inflammatory markers including NLR were measured within one week before the initiation of infliximab. Fifty-nine patients with moderate-to-severe active UC started treatment with infliximab and 37 patients (62.7%) experienced clinical response after induction therapy. Fourteen of 37 patients on maintenance therapy lost the response during follow-up. Baseline NLR of patients with LOR was significantly higher than in patients with sustained response. The NLR cut-off value of 4.488 was predictive of LOR, using receiver operating characteristic analysis (sensitivity: 78.6%, specificity: 78.3%). A univariate analysis revealed a significant relationship between relapse-free survival and the NLR (P = 0.018). Multivariate analysis indicated the NLR as an independent prognostic factor for LOR (hazard ratio = 3.86, 95% confidence interval: 1.20-12.4, P = 0.023). Baseline NLR is a useful prognostic marker in patients with moderate-to-severe active UC treated with infliximab, and may contribute to appropriate use of infliximab.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Analysis / Arthritis / Bioindicators / Biology and Life Sciences / Blood / Blood Cell Count / C-reactive protein / Cancer / Cardiovascular disease / Cardiovascular diseases / Care and treatment / Colitis, Ulcerative - blood / Colitis, Ulcerative - drug therapy / Colon / Confidence intervals / Coronary artery disease / Coronary heart disease / Crohn's disease / Dosage and administration / Drug dosages / Drug Resistance / Endoscopy / Female / Gastroenterology / Gastrointestinal Agents - administration & dosage / Gastrointestinal Agents - therapeutic use / Heart diseases / Humans / Immunoglobulins / Immunology / Immunotherapy / Induction therapy / Inflammation / Inflammatory bowel disease / Inflammatory bowel diseases / Inflammatory diseases / Infliximab / Infliximab - administration & dosage / Infliximab - therapeutic use / Lymphocytes / Lymphocytes - cytology / Male / Medical prognosis / Medical research / Medicine / Medicine and Health Sciences / Middle Aged / Monoclonal antibodies / Multivariate analysis / Neutrophils / Neutrophils - cytology / Patients / Physical Sciences / Prognosis / Research and Analysis Methods / Rheumatoid arthritis / Risk analysis / Risk factors / Sensitivity analysis / Therapy / TNF inhibitors / Tumor necrosis factor / Tumor necrosis factor-TNF / Tumor necrosis factor-α / Ulcerative colitis / University graduates