Observational studyBMC gastroenterology2025
Insights into the treatment of infliximab and vedolizumab in positive PR3-ANCA patients with moderately to severely active ulcerative colitis: multicenter real-world evidence.
Observational study in BMC gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsPerinuclear anti-neutrophil cytoplasmic antibody(p-ANCA) positivity may indicate poor response to infliximab (IFX) in ulcerative colitis (UC). Nevertheless, there has been limited research on the effect of proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) in UC patients treated with IFX and vedolizumab (VDZ). This study aimed to investigate the short-term efficacy of PR3-ANCA in patients with moderate-to-severe active UC.
methodsA total of 191 patients with moderate to severe active UC were enrolled from January 2021 to January 2024 in three centers in this retrospective, multicenter, real-world, case-control study. Patients with PR3-ANCA were allocated to two groups based on the biologics regimen (IFX or VDZ). Additionally, UC patients without positive PR3-ANCA, who were matched for baseline covariates including age, sex, BMI, disease duration, disease location, Mayo endoscopic subscore(MES), and prior advanced therapies, were selected at a ratio of 1:3. Clinical remission (CRm) and response (CRs), and endoscopic response (ERs) and remission(ERm) at week 22 were the endpoints.
resultsCompared to UC patients with negative PR3-ANCA, those with positive PR3-ANCA had lower rates of CRm (47.44% vs. 23.08%, P = 0.029), ERs (57.69% vs. 34.62%, P = 0.041), and ERm (39.74% vs. 11.54%, P = 0.008), but similar rates of CRs (69.23% vs. 65.38%, P = 0.715). However, there are no significant differences in rates of CRm (30.00% vs. 29.82%, P = 0.986), CRs (63.33% vs. 63.16%, P = 0.987), ERs (33.33% vs. 35.09%, P = 0.870), and ERm (20.00% vs. 21.05%, P = 0.908) between VDZ-treated patients with positive PR3-ANCA and negative. Additionally, compared to VDZ-treated patients, those treated with IFX had similar rates in CRm (30.00% vs. 23.08%, P = 0.560), CRs (63.33% vs. 65.38%, P = 0.873), ERs (33.33% vs. 34.62%, P = 0.920), and ERm (20.00% vs. 11.54%, P = 0.481). Rates in CRm (47.44% vs. 29.82%, P = 0.039), ERs (57.69% vs. 35.09%, P = 0.009), and ERm (39.74% vs. 21.05%, P = 0.021) in IFX-treated patients with negative PR3-ANCA were significantly higher than those in the VDZ-treated patients, but CRs was similar (69.23% vs. 63.16%, P = 0.460).
conclusionsPositive PR3-ANCA affects the efficacy of IFX rather than VDZ in patients with moderate to severe active UC. UC patients with positive PR3-ANCA results may benefit from the exploration of new treatment strategies.
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