Background: This study examined whether fecal calprotectin can be used in daily practice as a marker to monitor patients with ulcerative colitis (UC) receiving infliximab maintenance therapy.
Methods: This prospective multicenter study enrolled adult patients with UC in clinical remission under infliximab maintenance therapy. Fecal calprotectin levels were measured every 4 weeks. Sigmoidoscopies were performed at inclusion and at study end. Relapse was defined as a clinical need for change in treatment or an endoscopic Mayo subscore of ≥2 at week 52. Sustained deep remission was defined as a partial Mayo score <3 at all points and an endoscopic Mayo score 0 at week 52.
Results: Full analysis was possible for 87 of 113 included patients with UC (77%). Of these patients, 30 (34.4%) were considered to be in sustained deep remission and 13 (14.9%) to have relapsed. Calprotectin levels in patients with sustained deep remission remained very low (median < 40 mg/kg at all time points). Patients who flared had significantly higher calprotectin levels (median > 300 mg/kg) already 3 months before the flare. Further receiver operator curve analysis suggested that a calprotectin level >300 mg/kg had a reasonable sensitivity (58.3%) and specificity (93.3%) to model flare. Two consecutive calprotectin measurements of >300 mg/kg with 1-month interval were identified as the best predictor of flare (61.5% sensitivity and 100% specificity).
Conclusions: Fecal calprotectin can be used in daily practice to monitor patients with UC receiving infliximab maintenance therapy. Two consecutive measurements >300 mg/kg is more specific than a single measurement for predicting relapse.
1Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium;
2Department of Gastroenterology, University Hospital CHU of Liège, Liège, Belgium;
3Department of Gastroenterology, Oslo University Hospital, Ulleval, Oslo, Norway;
4Department of Gastroenterology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium;
5Department of Gastroenterology, University Hospital Leuven, Leuven, Belgium;
6Department of Gastroenterology, Cliniques Universitaires Saint-Luc UCL Saint Luc, Brussels, Belgium;
7Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands;
8Imelda GI Clinical Research Center, Bonheiden, Belgium;
9Department of Gastroenterology, Erasme Hospital, Brussels, Belgium;
10Department of Gastroenterology, H.-Hartziekenhuis Roeselare-Menen VZW Roeselare, Belgium;
11Medical Department, Sykehuset Innlandet Hospital Trust, Hamar, Norway;
12Medical Department of Østfold Hospital Trust, Fredrikstad, Norway;
13Department of Gastroenterology Sint Jozef kliniek, Bornem, Belgium;
14Department of Gastroenterology, Sint-Lucas General Hospital, Brugge, Belgium;
15Department of Gastroenterology & Hepatology, Antwerp University Hospital, Antwerp, Belgium;
16Department of Gastroenterology, Clinique St. Joseph, Liège, Belgium;
17Department of Medicine, Stavanger University Hospital, Stavanger, Norway;
18Department of Gastroenterology, Vestfold Hospital, Tønsberg, Norway;
19Department of Gastroenterology, AZ Damiann Oostende, Belgium;
20Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Sandvika, Norway;
21Department of Gastroenterology, Clinique St-Pierre, Ottignies, Belgium;
22Department of Gastroenterology, University Hospital, Brussels, Belgium;
23Gastroenterology Department, Clinique de l'Europe, Brussels, Belgium;
24Department of Gastroenterology, CHU Saint-Pierre, Brussels, Belgium;
25Department of Gastroenterology, St. Vincentius Hospital, Antwerp, Belgium;
26Division of Rheumatology, Sint Jozef kliniek, Borneum, Belgium;
27Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; and
28Department of Gastroenterology, Oost-Limburg Hospital, Genk, Belgium.
Reprints: Martine De Vos, Department of Gastroenterology, Ghent University Hospital, De Pintelaan 185, Gent 9000, Belgium (e-mail: firstname.lastname@example.org).
The authors have no conflicts of interest to disclose.
Received March 15, 2013
Accepted May 9, 2013