Faecal Calprotectin Is a Very Reliable Tool to Predict and Monitor the Risk of Relapse after Therapeutic De-escalation in Patients with Inflammatory Bowel Diseases

Anthony Buisson, Wing Yan Mak, Michael J. Andersen, Donald Lei, Stacy A. Kahn, Joel Pekow, Russel D. Cohen, Nada Zmeter, Bruno Pereira, David T. Rubin

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Aims: To assess faecal calprotectin [Fcal] levels before and after therapeutic de-escalation, to predict clinical relapse in patients with inflammatory bowel disease [IBD]. Methods: From a prospectively maintained database, we enrolled 160 IBD patients [112 Crohn's disease/48 ulcerative colitis] in clinical remission, with Fcal measured within 8 weeks before therapeutic de-escalation. Clinical relapse was defined using the Harvey-Bradshaw index or Simple Clinical Colitis Activity Index. Results: Using a receiver operating characteristic [ROC] curve, Fcal >100 μg/g was the best threshold to predict clinical relapse after therapeutic de-escalation (area under the curve [AUC] = 0.84). In multivariate analysis, clinical remission >6 months before therapeutic de-escalation (hazard ratio [HR] = 0.57 [0.33-0.99]; p = 0.044) was associated with decreased risk of relapse, whereas current steroid medication (= 1.67[1.00-2.79]; p <0.0001) was a risk factor. Fcal >100 μg/g was predictive of clinical relapse (HR = 3.96 [2.47-6.35]; p < 0.0001) in the whole cohort but also in patients receiving anti-tumour necrosis factor [TNF] agents [n = 85 patients; p <0.0001], anti-integrins [n = 32; p = 0.003], or no biologics [n = 43; p = 0.049], or attempting to discontinue steroids [n = 37; p = 0.001]. One patient [1/98] and seven patients [7/88, 8.0%] with baseline Fcal <100 μg/g relapsed within 3 months and 6 months after therapeutic de-escalation, respectively. A total of 74 Fcal measurements were performed in 52 patients after therapeutic de-escalation. Monitoring Fcal >200 μg/g [ROC curve with AUC = 0.96] was highly predictive of clinical relapse in multivariate analysis ([HR = 31.8 [3.5-289.4], p = 0.002). Only two relapses [2/45, 4.4%] occurred within 6 months while Fcal <200 μg/g. Conclusions: Fcal level is highly accurate to predict and monitor the risk of relapse after therapeutic de-escalation in IBD patients and could be used in daily practice.

Original languageEnglish
Article numberjjz023
Pages (from-to)1012-1024
Number of pages13
JournalJournal of Crohn's and Colitis
Volume13
Issue number8
DOIs
StatePublished - Aug 14 2019

Keywords

  • Inflammatory bowel disease
  • faecal calprotectin
  • therapeutic de-escalation

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