TY - JOUR
T1 - 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
AU - Buisson, Anthony
AU - Mak, Wing Yan
AU - Andersen, Michael J.
AU - Lei, Donald
AU - Kahn, Stacy A.
AU - Pekow, Joel
AU - Cohen, Russel D.
AU - Zmeter, Nada
AU - Pereira, Bruno
AU - Rubin, David T.
N1 - Funding Information:
AB declare lecture fees for MSD, Abbvie, Ferring, Takeda, Vifor Pharma, Hospira, and consulting fees for Abbvie, Takeda, and Hospira. DTR declares consultant fees for Abbvie, Abgenomics, Allergan, Amgen, Celgene, Forward Pharma, Genentech/Roche, Janssen Pharmaceuticals, Merck, Miraca Life Sciences, Napo Pharmaceuticals, Pfizer, Salix Pharmaceuticals, Samsung Bioepis, Sandoz Pharmaceuticals, Shire, Takeda, and grant support from Abbvie, Genentech/Roche, Janssen Pharmaceuticals, Prometheus Laboratories, Shire, Takeda, and UCB Pharma. The other authors declare no conflict of interest related to this work
Publisher Copyright:
© 2019 European Crohn's and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved.
PY - 2019/8/14
Y1 - 2019/8/14
N2 - 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.
AB - 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.
KW - Inflammatory bowel disease
KW - faecal calprotectin
KW - therapeutic de-escalation
UR - http://www.scopus.com/inward/record.url?scp=85068211350&partnerID=8YFLogxK
U2 - 10.1093/ecco-jcc/jjz023
DO - 10.1093/ecco-jcc/jjz023
M3 - Article
C2 - 30726887
AN - SCOPUS:85068211350
SN - 1873-9946
VL - 13
SP - 1012
EP - 1024
JO - Journal of Crohn's and Colitis
JF - Journal of Crohn's and Colitis
IS - 8
M1 - jjz023
ER -