J Crohns Colitis. 2023 Aug 21;17(8):1262-1277.doi: 10.1093/ecco-jcc/jjad049.

Maria M E Jongsma ¹, Lea M M Costes ², Irma Tindemans ², Martinus A Cozijnsen ¹, Rolien H C Raatgreep ², Merel van Pieterson ¹, Yunlei Li ³, Johanna C Escher ¹, Lissy de Ridder ¹, Janneke N Samsom ²

Author information

¹Department of Pediatric Gastroenterology, Erasmus University Medical Center/Sophia Children's Hospital, Rotterdam, the Netherlands.

²Laboratory of Pediatrics, Division of Gastroenterology and Nutrition, Erasmus University Medical Center/Sophia Children's Hospital, Rotterdam, the Netherlands.

³Department of Pathology & Clinical Bioinformatics, Erasmus University Medical Center/Erasmus MC Cancer Institute, Rotterdam, the Netherlands.

Abstract

Background: Despite its efficacy, rational guidance for starting/stopping first-line biologic treatment in individual paediatric Crohn's disease [CD] patients is needed. We assessed how serum immune profiles before and after first-line infliximab [FL-IFX] or conventional [CONV] induction therapy associate with disease remission at week 52.

Methods: Pre- [n = 86], and 10-14-week post-treatment [n = 84] sera were collected from patients with moderate-to-severe paediatric CD in the TISKids trial, randomized to FL-IFX [n = 48; five 5-mg/kg infusions over 22 weeks] or CONV [n = 43; exclusive enteral nutrition or oral prednisolone]; both groups received azathioprine maintenance. The relative concentrations of 92 inflammatory proteins were determined with Olink Proteomics; fold changes [FC] with |log2FC| > 0.5 after false discovery rate adjustment were considered significant.

Results: FL-IFX modulated a larger number of inflammatory proteins and induced stronger suppression than CONV; 18/30 proteins modulated by FL-IFX were not regulated by CONV. Hierarchical clustering based on IFX-modulated proteins at baseline revealed two clusters of patients: CD-hi patients had significantly higher concentrations of 23/30 IFX-modulated proteins [including oncostatin-M, TNFSF14, HGF and TGF-α], and higher clinical disease activity, C-reactive protein and blood neutrophils at baseline than CD-lo patients. Only 24% of CD-hi FL-IFX-treated patients maintained remission without escalation at week 52 vs 58% of CD-lo FL-IFX-treated patients. Similarly, 6% of CD-hi CONV-treated patients achieved remission vs 20% of CONV-treated CD-lo patients. Clustering based on immune profiles post-induction therapy did not relate to remission at week 52.

Conclusion: FL-IFX leads to stronger reductions and modulates more immune proteins than CONV. Stratification on pre-treatment profiles of IFX-modulated proteins directly relates to maintenance of remission without treatment escalation.

Trial registration number: NCT02517684.