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Background and aims <p>Perinuclear 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.</p> Methods <p>A 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.</p> Results <p>Compared to UC patients with negative PR3-ANCA, those with positive PR3-ANCA had lower rates of CRm (47.44% vs. 23.08%, <i>P</i> = 0.029), ERs (57.69% vs. 34.62%, <i>P</i> = 0.041), and ERm (39.74% vs. 11.54%, <i>P</i> = 0.008), but similar rates of CRs (69.23% vs. 65.38%, <i>P</i> = 0.715). However, there are no significant differences in rates of CRm (30.00% vs. 29.82%, <i>P</i> = 0.986), CRs (63.33% vs. 63.16%, <i>P</i> = 0.987), ERs (33.33% vs. 35.09%, <i>P</i> = 0.870), and ERm (20.00% vs. 21.05%, <i>P</i> = 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%, <i>P</i> = 0.560), CRs (63.33% vs. 65.38%, <i>P</i> = 0.873), ERs (33.33% vs. 34.62%, <i>P</i> = 0.920), and ERm (20.00% vs. 11.54%, <i>P</i> = 0.481). Rates in CRm (47.44% vs. 29.82%, <i>P</i> = 0.039), ERs (57.69% vs. 35.09%, <i>P</i> = 0.009), and ERm (39.74% vs. 21.05%, <i>P</i> = 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%, <i>P</i> = 0.460).</p> Conclusions <p>Positive 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.</p>

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Insights into the treatment of infliximab and vedolizumab in positive PR3-ANCA patients with moderately to severely active ulcerative colitis: multicenter real-world evidence

  • 期刊论文

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  • 发表日期：

    2025年11月28日

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  • Qi Yu,
  • Yiyu Cheng,
  • Fang Liu,
  • Yidong Chen,
  • Jiamin Li,
  • Xiaopeng Zhang,
  • Xiaoyu Fu,
  • Junrong Li,
  • Liangru Zhu

摘要

Background and aims

Perinuclear 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.

Methods

A 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.

Results

Compared 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).

Conclusions

Positive 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.