Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis
Abstract Background Serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) is a disease-specific antibody against granulomatosis with polyangiitis. PR3-ANCA is a useful serological marker for disease severity in ulcerative colitis (UC). The purpose of this study was to investigate wh...
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BMC
2021-08-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-021-01903-5 |
| _version_ | 1819109301193539584 |
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| author | Yuki Aoyama Tomoki Inaba Sakuma Takahashi Hisae Yasuhara Sakiko Hiraoka Takeshi Morimoto Hugh Shunsuke Colvin Masaki Wato Midori Ando Satoko Nakamura Koichi Mizobuchi Hiroyuki Okada |
| author_facet | Yuki Aoyama Tomoki Inaba Sakuma Takahashi Hisae Yasuhara Sakiko Hiraoka Takeshi Morimoto Hugh Shunsuke Colvin Masaki Wato Midori Ando Satoko Nakamura Koichi Mizobuchi Hiroyuki Okada |
| author_sort | Yuki Aoyama |
| collection | DOAJ |
| description | Abstract Background Serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) is a disease-specific antibody against granulomatosis with polyangiitis. PR3-ANCA is a useful serological marker for disease severity in ulcerative colitis (UC). The purpose of this study was to investigate whether PR3-ANCA levels could also predict the success of induction therapy and to compare its performance against other markers, including serum CRP and fecal hemoglobin. Methods This was a multicenter retrospective study. In total, 159 patients with active-phase UC underwent colonoscopy. Disease activity was measured using the Mayo endoscopic subscore (MES). PR3-ANCA positivity and the response to induction therapy, either 5-aminosalicylic acid or steroid, were assessed. PR3-ANCA, CRP, and fecal hemoglobin were measured during the active phase, and during clinical remission. Results Eighty-five (53.5%) of 159 patients with active UC were positive for PR3-ANCA. PR3-ANCA titers were significantly higher in the group of patients with MES 3 compared to patients with MES 1 (P = 0.002) or MES 2 (P = 0.035). Steroid therapy was administered to 56 patients with a median partial Mayo score of 7 (5–9), which is equivalent to moderate-to-severe disease activity. PR3-ANCA positivity of non-responders to steroid therapy was significantly higher than that of responders (71.9% vs, 41.7%, P = 0.030), whereas CRP and fecal hemoglobin were not predictive of steroid response. Multivariate analysis demonstrated that PR3-ANCA positivity was associated with non-response to steroid therapy (odds ratio 5.19; 95% confidence interval, 1.54–17.5; P = 0.008). Of the 37 patients treated to clinical remission who were also positive for PR3-ANCA during the active phase, 27 had an MES of ≥ 1, and 10 patients had an MES of 0. In clinical remission, the proportion of patients with MES 0 in 17 patients whose PR3-ANCA became negative was significantly higher than that in 20 patients whose PR3-ANCA remained positive (47.1% vs. 10.0%, P = 0.023). Conclusions PR3-ANCA not only serves as a marker of disease activity, but also predicts the failure of steroid therapy in moderate-to-severe UC. Trial registration: This study was retrospectively registered in the UMIN Clinical Trials Registry System (000039174) on January 16, 2020. |
| first_indexed | 2024-12-22T03:23:39Z |
| format | Article |
| id | doaj.art-c403d00cefe34cb79e9624a649a1b9be |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-22T03:23:39Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
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| series | BMC Gastroenterology |
| spelling | doaj.art-c403d00cefe34cb79e9624a649a1b9be2022-12-21T18:40:39ZengBMCBMC Gastroenterology1471-230X2021-08-0121111210.1186/s12876-021-01903-5Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitisYuki Aoyama0Tomoki Inaba1Sakuma Takahashi2Hisae Yasuhara3Sakiko Hiraoka4Takeshi Morimoto5Hugh Shunsuke Colvin6Masaki Wato7Midori Ando8Satoko Nakamura9Koichi Mizobuchi10Hiroyuki Okada11Department of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology, Mitoyo General HospitalDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesDepartment of Clinical Epidemiology, Hyogo College of MedicineDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Pathology, Kagawa Prefectural Central HospitalDepartment of Pathology, Kagawa Prefectural Central HospitalDepartment of Pathology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAbstract Background Serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) is a disease-specific antibody against granulomatosis with polyangiitis. PR3-ANCA is a useful serological marker for disease severity in ulcerative colitis (UC). The purpose of this study was to investigate whether PR3-ANCA levels could also predict the success of induction therapy and to compare its performance against other markers, including serum CRP and fecal hemoglobin. Methods This was a multicenter retrospective study. In total, 159 patients with active-phase UC underwent colonoscopy. Disease activity was measured using the Mayo endoscopic subscore (MES). PR3-ANCA positivity and the response to induction therapy, either 5-aminosalicylic acid or steroid, were assessed. PR3-ANCA, CRP, and fecal hemoglobin were measured during the active phase, and during clinical remission. Results Eighty-five (53.5%) of 159 patients with active UC were positive for PR3-ANCA. PR3-ANCA titers were significantly higher in the group of patients with MES 3 compared to patients with MES 1 (P = 0.002) or MES 2 (P = 0.035). Steroid therapy was administered to 56 patients with a median partial Mayo score of 7 (5–9), which is equivalent to moderate-to-severe disease activity. PR3-ANCA positivity of non-responders to steroid therapy was significantly higher than that of responders (71.9% vs, 41.7%, P = 0.030), whereas CRP and fecal hemoglobin were not predictive of steroid response. Multivariate analysis demonstrated that PR3-ANCA positivity was associated with non-response to steroid therapy (odds ratio 5.19; 95% confidence interval, 1.54–17.5; P = 0.008). Of the 37 patients treated to clinical remission who were also positive for PR3-ANCA during the active phase, 27 had an MES of ≥ 1, and 10 patients had an MES of 0. In clinical remission, the proportion of patients with MES 0 in 17 patients whose PR3-ANCA became negative was significantly higher than that in 20 patients whose PR3-ANCA remained positive (47.1% vs. 10.0%, P = 0.023). Conclusions PR3-ANCA not only serves as a marker of disease activity, but also predicts the failure of steroid therapy in moderate-to-severe UC. Trial registration: This study was retrospectively registered in the UMIN Clinical Trials Registry System (000039174) on January 16, 2020.https://doi.org/10.1186/s12876-021-01903-5Ulcerative colitisBiomarkersAntineutrophil cytoplasmic antibodySteroidsRefractoryColonoscopy |
| spellingShingle | Yuki Aoyama Tomoki Inaba Sakuma Takahashi Hisae Yasuhara Sakiko Hiraoka Takeshi Morimoto Hugh Shunsuke Colvin Masaki Wato Midori Ando Satoko Nakamura Koichi Mizobuchi Hiroyuki Okada Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis BMC Gastroenterology Ulcerative colitis Biomarkers Antineutrophil cytoplasmic antibody Steroids Refractory Colonoscopy |
| title | Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis |
| title_full | Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis |
| title_fullStr | Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis |
| title_full_unstemmed | Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis |
| title_short | Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis |
| title_sort | anti proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis |
| topic | Ulcerative colitis Biomarkers Antineutrophil cytoplasmic antibody Steroids Refractory Colonoscopy |
| url | https://doi.org/10.1186/s12876-021-01903-5 |
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