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Anti-Saccharomyces Cerevisiae Antibodies as a Prognostic Biomarker in Children with Crohn's disease

Chandrakumar, Abina,b,c; Georgy, Michaelc; Agarwal, Prasoona,d,e; Jong, Geert Willem ‘ta,b,d,f; El-Matary, Waelc,f

Journal of Pediatric Gastroenterology and Nutrition: February 14, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002311
Original Article: Gastroenterology: PDF Only
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Objective: Although anti-saccharomyces cerevisiae antibodies (ASCA) could be a useful biomarker in differentiating Crohn's disease (CD) from ulcerative colitis (UC), their role as prognostic markers in children with CD has been under-investigated. This longitudinal prospective observational study aimed to assess the prognostic value of ASCA status among children with CD managed using biologics.

Methods: The study population comprised of children with inflammatory bowel disease (IBD) diagnosed with CD from 2012 to 2018. Cox-regression model with adjustment for a priori covariates was used to examine the response to anti-tumor necrosis factor (TNF) biological therapy among ASCA positive patients in comparison to ASCA negative patients.

Results: There were 273 measurements available from the study cohort comprising of children with CD, who were followed up for a median duration of 14 months (IQR 5-42). ASCA positive patients had a higher risk for moderate to severe clinical disease (odds ratio (OR) 2.88; 95% confidence interval (CI) 1.2–7.55) and extensive endoscopic distribution (OR 3.30; CI 1.12–9.74) at baseline in comparison to ASCA negative patients respectively. In comparison to ASCA IgG negative patients, ASCA IgG positive patients who were treated with biologics had a significantly lower relapse rate (aHR 0.12; CI 0.02–0.93). Ten (14%) patients had an unstable ASCA value with either ASCA IgA or ASCA IgG status changing from positive to negative or vice versa.

Conclusions: ASCA positive children with CD present with more extensive (endoscopic) and clinically severe disease. ASCA IgG is a useful prognostic marker among children with CD who receive biologics.

aDepartment of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, MB, Canada

bClinical Research Unit, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada

cSection of Pediatric Gastroenterology, Winnipeg Children's Hospital, Max Rady College of Medicine, Rady Faculty of Health Sciences and Children's Hospital Research Institute, Winnipeg, MB, Canada

dManitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION), University of Manitoba, Winnipeg, MB, Canada

eDiabetes Research Envisioned and Accomplished in Manitoba (DREAM), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada

fDepartment of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences and Children's Hospital Research Institute, Winnipeg, MB, Canada.

Address correspondence and reprint requests to Wael El-Matary, MBBCh, MD, MSc, FRCPCH, FRCPC, Dr. Head, Section of Pediatric Gastroenterology. Professor, Department of Pediatric and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, AE 408 Children's Hospital, Health Sciences Centre, 840 Sherbrook St., Winnipeg, Manitoba, R3A 1S1, Canada (e-mail: welmatary@exchange.hsc.mb.ca).

Received 20 October, 2018

Revised 13 December, 2018

Accepted 16 January, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

Abin Chandrakumar and Michael Georgy: Shared first authors.

Conflict of Interest: Dr. El-Matary served as an advisory board member for both Janssen Canada and AbbVie Canada. He also received research support for Janssen Canada.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,