Zusammenfassung
Objective Associations between HLA-DR genotypes and susceptibility to Crohn's disease (CID) have been reported. However, it is not known whether certain HLA-DR genotypes or IL-1ra gene polymorphism are associated with responsiveness to treatment or different clinical patterns of disease. Design/setting In a large, randomized, controlled multicentre trial, 318 patients with CD were treated with ...
Zusammenfassung
Objective Associations between HLA-DR genotypes and susceptibility to Crohn's disease (CID) have been reported. However, it is not known whether certain HLA-DR genotypes or IL-1ra gene polymorphism are associated with responsiveness to treatment or different clinical patterns of disease. Design/setting In a large, randomized, controlled multicentre trial, 318 patients with CD were treated with daily doses of 6, 9 or 18 mg budesonide. Patients were stratified into two groups: patients without steroid pretreatment and with active CID (CDAI > 150) and patients with conventional steroid pretreatment of less than or equal to 30 mg prednisolone per day, which was replaced by oral budesonide within 3 weeks. Main outcome measures The HLA-DRB1 genotypes 1-16 and the IL-1ra gene polymorphism were examined for an association with budesonide treatment failure. Results Only HLA-DR 8 was associated with treatment failure of budesonide. HLA-DR 8 is not very common. Only 17/243 patients who could be evaluated expressed this genotype, and 13 of these 17 patients did not respond to budesonide (P < 0.00067). Neither the other HLA-DR genotypes nor the IL-1ra gene polymorphisim had an influence on treatment outcome of budesonide therapy. No significant association of fistulas, perianal disease, need for bowel resections, and disease localization with certain HLA-DRB1 genotypes or the IL-1ra gene polymorphism were found. Conclusions This is the first description of an association of a certain HLA-DR genotype (HLA-DR 8) with treatment failure in inflammatory bowel disease (IBD). (C) 2001 Lippincott Williams & Wilkins.
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