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Identifier 000445606
Title Βελτιστοποίηση της θεραπείας με βιολογικούς παράγοντες σε ασθενείς με ιδιοπαθείς φλεγμονώδεις νόσους του εντέρου
Alternative Title Optimizing biologic therapy in patients with Inflammatory Bowel Diseases
Author Ορφανουδάκη, Ελένη
Thesis advisor Κουτρουμπάκης, Ιωάννης
Reviewer Μουζάς, Ιωάννης
Ρωμανός, Ιωάννης
Καλαϊτζάκης, Ευάγγελος
Τζαρδή, Μαρία
Κοφτερίδης, Διαμαντής
Σιδηρόπουλος, Πρόδρομος
Abstract Treatment optimization and tight control have been suggested as important parameters in the management of patients with Inflammatory Bowel Disease (IBD). Towards this direction, the often use of colonoscopy as well as various biomarkers have been suggested. The aim of this thesis is to investigate potential serum or fecal biomarkers,that could reliably, accurately and objectively predict disease activity, assisting the treatment optimization strategy. In this way, a documented, and not only a clinically guided (empirical) approach is applied in treatment optimization preserving both drug survival and patient safety. The measurement of infliximab trough levels (IFX-TLs) and antibodies to infliximab (Abs) has been suggested as an important parameter for the optimization of treatment in patients with IBD. In the first part of the thesis we aimed to estimate the patterns overtime of IFX-TLs and Abs in IBD patients on maintenance treatment with IFX. In two consecutive measurements, taken 10 months apart, IFX-TLs showed significantly decreasing patterns associated with an increase of CRP values. This observation may be suggestive of an impending loss of response and highlights the need for treatment intensification when detected. In fact 3 years later upon recording of all treatment modifications made during this period in the same patient group we retrospectively found that the decrease in IFX-TLs was more evident in those who eventually needed treatment optimization (based on clinical, laboratory and endoscopic criteria) in the years to follow than those that did not. Fecal calprotectin (FC) is also a valuable tool with widespread use in IBD demonstrating a favorable positive correlation with disease endoscopic activity. Recently, in support of self-monitoring strategies and distance medicine, smartphone-based home FC tests have been developed showing high accuracy and good correlation with laboratory ELISA FC measurements. We aimed to compare FC home test with other biomarkers as for their association with endoscopic activity in IBD patients under maintenance treatment with adalimumab. FC home test performed better than all serum biomarkers in predicting endoscopic activity. In conclusion, this thesis describes how the use of inflammatory markers, drug levels and anti-drug antibody levels help to optimize the outcome of anti-TNFα therapy in patients with IBD.
Language Greek
Subject Crohns disease
Ελκώδης κολίτιδα
Νόσος Crohn
Issue date 2022-03-30
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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