Effects of tumor necrosis factor antagonists in patients with primary sclerosing cholangitis
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Background & aims Few patients with primary sclerosing cholangitis (PSC) and inflammatory bowel diseases (IBDs) are exposed to tumor necrosis factor (TNF) antagonists because of the often mild symptoms of IBD. We assessed the effects of anti-TNF agents on liver function in patients with PSC and IBD, and their efficacy in treatment of IBD.Methods We performed a retrospective analysis of 141 patients with PSC and IBD receiving treatment with anti-TNF agents (infliximab or adalimumab) at 20 sites (mostly tertiary-care centers) in Europe and North America. We collected data on the serum level of alkaline phosphatase (ALP). IBD response was defined as either endoscopic response or, if no endoscopic data were available, clinical response, as determined by the treating clinician or measurements of fecal calprotectin. Remission was defined more stringently as endoscopic mucosal healing. We used linear regression analysis to identify factors associated significantly with level of ALP during anti-TNF therapy.Results Anti-TNF treatment produced a response of IBD in 48% of patients and remission of IBD in 23%. There was no difference in PSC symptom frequency before or after drug exposure. The most common reasons for anti-TNF discontinuation were primary nonresponse of IBD (17%) and side effects (18%). At 3 months, infliximab-treated patients had a median reduction in serum level of ALP of 4% (interquartile range, reduction of 25% to increase of 19%) compared with a median 15% reduction in ALP in adalimumab-treated patients (interquartile range, reduction of 29% to reduction of 4%; P = .035). Factors associated with lower ALP were normal ALP at baseline (P < .01), treatment with adalimumab (P = .090), and treatment in Europe (P = .083).Conclusions In a retrospective analysis of 141 patients with PSC and IBD, anti-TNF agents were moderately effective and were not associated with exacerbation of PSC symptoms or specific side effects. Prospective studies are needed to investigate the association between use of adalimumab and reduced serum levels of ALP further.
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Anti-TNF treatment is moderately effective for gut inflammation in PSC-IBD and no concerning safety signals were found.
“Treatment was shown to be moderately effective for gut inflammation and no concerning safety signals were found.”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [182]
Side effects of anti-TNF treatment in PSC-IBD are similar to those in IBD alone, with no exacerbation of PSC symptoms or specific liver-related side effects.
“The side effects of anti-TNF treatment in PSC-IBD are reported to be similar to those in IBD alone, and no exacerbation of PSC symptoms or specific liver-related side effects have been noted.182”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [182]
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Self-citation
- Authors
- Hedin, C. R. H., Sado, G., Ndegwa, N., Lytvyak, E., Mason, A., Montano-Loza, A., Gerussi, A., Saffioti, F., Thorburn, D., Nilsson, E., Larsson, G., Moum, B. A., van Munster, K. N., Ponsioen, C. Y., Levy, C., Nogueira, N. F., Bowlus, C. L., Gotlieb, N., Shibolet, O., Lynch, K. D., Chapman, R. W., Rupp, C., Vesterhus, M., Jørgensen, K. K., Rorsman, F., Schramm, C., Sabino, J., Vermeire, S., Zago, A., Cazzagon, N., Marschall, H.-U., Ytting, H., Ben Belkacem, K., Chazouilleres, O., Almer, S., & Bergquist, A.
- Affiliations
- Karolinska University Hospital (SE)
- Karolinska Institutet (SE)
- University of Alberta (CA)
- National Health Service (GB)
- University of Messina (IT)
- Lund University (SE)
- Oslo University Hospital (NO)
- Amsterdam UMC Location University of Amsterdam (NL)
- University of Miami (US)
- University of California Davis Medical Center (US)
- Tel Aviv University (IL)
- University of Oxford (GB)
- University Hospital Heidelberg (DE)
- Haraldsplass Diakonale Sykehus (NO)
- Akershus University Hospital (NO)
- Uppsala University Hospital (SE)
- University Medical Center Hamburg-Eppendorf (DE)
- Universitair Ziekenhuis Leuven (BE)
- University of Padua (IT)
- Sahlgrenska University Hospital (SE)
- Hvidovre Hospital (DK)
- Corresponding author
- Hedin, Charlotte Rose Hawkey
- ORCID
- Hedin, Charlotte Rose Hawkey
- Sado, Gina
- Ndegwa, Nelson
- Lytvyak, Ellina
- Mason, Andrew
- Gerussi, Alessio
- Saffioti, Francesca
- Thorburn, Douglas
- Nilsson, Emma
- Moum, Bjørn A.
- Ponsioen, Cyriel Y.
- Levy, Cynthia
- Nogueira, Nicholas F.
- Bowlus, Christopher L.
- Gotlieb, Neta
- Shibolet, Oren
- Lynch, Kate D.
- Chapman, Roger W.
- Rupp, Christian
- Vesterhus, Mette
- Jørgensen, Kristin K.
- Rorsman, Fredrik
- Schramm, Christoph
- Sabino, João
- Zago, Alessandra
- Cazzagon, Nora
- Marschall, Hanns-Ulrich
- Ytting, Henriette
- Almer, Sven
- Bergquist, Annika
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 18
- Issue
- 10
- Pages
- 2295-2304.e2
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W3006314725
- Cited by
- 52
- References
- 22
- Citations by year
- 2026: 13 · 2025: 10 · 2024: 10 · 2023: 8 · 2022: 6 · 2021: 3 · 2020: 2
- FWCI
- 2.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Lirias (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion, other-oa)
- Funders
- Università degli Studi di Udine
- Erasmus+
- Cancerfonden
- Stockholms Läns Landsting
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Keywords
- primary sclerosing cholangitis, inflammatory bowel disease, tumor necrosis factor inhibitors, infliximab, adalimumab, alkaline phosphatase, liver function, endoscopic healing, remission, treatment response, adverse drug reactions
- MeSH terms
- Adalimumab, Infliximab, Tumor Necrosis Factor Inhibitors, Humans, Retrospective Studies, Tumor Necrosis Factor-alpha, Cholangitis, Sclerosing, Inflammatory Bowel Diseases
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