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[PMC free article] [PubMed] [CrossRef] [Google Scholar] 17. p<0.001). The median infliximab trough level (TL) was lower in patients with AGRs <1.47 than in those with AGRs 1.47. Anti-drug antibody (ADA) concentrations were negatively correlated with the AGR at 1 year of anti-TNF- therapy (r=C0.413, p=0.032). Conclusions AGR can be used to predict relapse. Patients with AGRs <1.47 at 1 year after anti-TNF- therapy are more likely to have low drug TLs and develop ADAs, which increase the possibility of relapse than those with AGRs 1.47. Therefore, if the AGR at 1 year after anti-TNF- therapy is usually less Buserelin Acetate than 1.47, clinicians should monitor disease activity, assess the TLs of the anti-TNF- brokers, test for ADAs and determine the appropriate therapeutic strategies. Keywords: Albumin-to-globulin ratio, Relapse, Crohn disease, Pediatric INTRODUCTION Crohns Buserelin Acetate disease (CD) is a type of inflammatory bowel disease (IBD) that causes chronic inflammation of entire gastrointestinal tract.1 The exact c-Raf cause of CD remains unknown. However, the currently accepted hypotheses for IBD emphasized the conversation of heredity, environment, and impaired immune system.1,2 The disease course of CD is usually progressive and characterized by periods of clinical remission and relapse.3 It is generally known that pediatric-onset CD is different from that in adults because there is the possibility of linear growth impairment, delayed puberty and the disease Buserelin Acetate is more progressive, extensive, and complicated.4,5 Recent studies conducted in adult patients with CD have been reported that factors related to relapse at diagnosis are young diagnosis age, upper gastrointestinal or perianal involvement and stricturing or penetrating disease behavior.6-8 There is paucity in the literature on predicting factors related to relapse in pediatric patients with CD. One study reported that there are no significant positive risk factors associated with relapse and another reported low body mass index at diagnosis is related to increased risk of relapse.9,10 In contrast, other literature reported that early disease-course factors, such as response to treatment, are more important in predicting early relapse in pediatric patients with CD than disease activity or disease phenotype at diagnosis.11 Efficacy of treatment, especially anti-tumor necrosis factor (TNF) in patients with CD, is Buserelin Acetate affected by serum drug concentrations. Serum drug concentration is influenced by dosage according to body weight,12 degradation of drug,13 anti-drug antibodies (ADA) to anti-TNF-,14 or drug leakage into gastrointestinal tract.15,16 Anti-TNF- administered to a patient can induce an immune reaction such as the development of ADA, which is associated with low drug trough levels (TLs) and can mediate loss of clinical response to the drug.14,17 Buserelin Acetate Albumin is not only used to reflect nutritional status and systemic inflammatory response of patients,18 but also used to protect from your catabolism-based degradation of drugs, such as anti-TNF-.19 Globulin displays not as well as inflammation but also immune response to antigenic stimulation such as immunoglobulin formation. The hypothesis of the study is usually that albumin and globulin which are related to anti-TNF- TLs and ADA formation will be associated with relapse in pediatric patients with CD on maintenance anti-TNF- therapy. We aimed to evaluate the importance of albumin and globulin as prognostic biomarkers in patients with CD to anti-TNF- therapy. MATERIALS AND METHODS 1. Patients This study was designed as a retrospective observational study conducted at the Department of Pediatrics, Samsung Medical Center between January 2010 and February 2019. Eligible patients had active CD and were under 18 years of age at the time of diagnosis and first treatment with anti-TNF-. Patients diagnosed as ulcerative colitis, IBD-unspecified, main nonresponders to anti-TNF-, diagnosed ages of more than 18 years old or those with missing data on baseline clinical demographics were excluded. In addition, the subjects experienced received scheduled anti-TNF- for at least 1 year and maintained clinical remission for at least 3 months from induction therapy of anti-TNF- to clearly distinguish relapse from uncontrolled disease activity sustained from diagnosis. CD was diagnosed in accordance with the revised Porto criteria of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition20 and disease phenotype classification was based on the Paris classification. 21 Anti-TNF- included both infliximab and adalimumab. Infliximab was administered as an induction regimen of 5 mg/kg at 0,.