Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can be used to predict mucosal healing (MH) in patients with ulcerative colitis (UC) treated with anti-tumor necrosis factor (anti-TNF) in monotherapy, according to study results published in Inflammatory Bowel Diseases.
Anti-TNFs are widely used in UC treatment, yet many patients with UC experience loss of response during the first year of therapy. Ongoing studies suggest that NLR and PLR can be useful biomarkers of many systemic inflammatory responses. Consequently, researchers aimed to assess whether NLR and PLR could be used as prognostic markers of anti-TNF treatment response in UC.
A total of 88 patients with UC (48 men, mean age, 44.9 years) who started anti-TNF treatment in monotherapy were evaluated at the University Hospitals of Pisa, Padua, and Genoa from January 2017 to March 2018. Patients with concomitant corticosteroid treatment ≥20 mg were excluded. NLR, PLR, and fecal calprotectin before treatment and after induction were evaluated. NLR and PLR values were correlated with clinical remission and MH at the end of follow-up (54 weeks).
Results showed a strong correlation between high NLR values and—to a lesser extent—high PLR values with therapeutic outcomes including MH and clinical remission. Patients who reached MH after 54 weeks of anti-TNF therapy exhibited lower levels of baseline NLR and PLR compared to those who did not achieve MH (1.93 [1.42-2.57] vs 2.95 [2.14-3.99]; P = 0.0001 and 140.0 [95.0-179.7] vs 167.9 [112.5-224.8]; P = 0.04, respectively. Comparable results were attained at week 8 (P = 0.0001 and P = 0.001, respectively). Regarding clinical remission at 54 weeks, NLR values were lower in patients who obtained clinical remission than in patients who did not, both at baseline (2.04 [1.49-3.05] vs 2.99 [2.34-3.94]; P = 0.0009) and at week 8 (1.30 [1.10-2.00] vs 2.59 [1.90-2.95]; P = 0.0001). Similarly, PLR values were lower in patients reached clinical remission at 54 weeks than in patients who did not, at both baseline (145.3 [95.0-187.5] vs 169.8 [116.0-244.4]; P = 0.04) and at week 8 (111.9 [85.0-171.5] vs 146.0 [114.1-200.6]; P = 0.02). Furthermore, patients who had active ulcers at baseline endoscopic evaluation had higher baseline NLR and PLR values compared with those without detected ulcers.
Limitations of the study include the retrospective design and the small sample size.
The researchers concluded that the study “paves the way for future prospective multicenter studies to confirm the strong association of NLR and PLR with the outcome of anti-TNF therapy.”
Bertani L, Rossari F, Barberio B, Demarzo MG, Tapete G, Albano E. Novel prognostic biomarkers of mucosal healing in ulcerative colitis patients treated with anti-TNF: neutrophil-to lymphocyte ratio and platelet-to-lymphocyte ratio. Inflamm Bowel Dis. 2020;Mar 31. pii: izaa062.