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Consecutive Fecal Calprotectin Measurements to Predict Relapse in Patients with Ulcerative Colitis Receiving Infliximab Maintenance Therapy

Vos, Martine De MD, PhD1; Louis, Edouard J. MD, PhD2; Jahnsen, Jørgen MD, PhD3; Vandervoort, Jo G.P. MD4; Noman, Maja MD5; Dewit, Olivier MD, PhD6; D'Haens, Geert R. PMD, PhD7,8; Franchimont, Denis MD, PhD9; Baert, Filip J. MD10; Torp, Roald A. MD11; Henriksen, Magne MD, PhD12; Potvin, Philippe M.R. MD13; Van Hootegem, Philippe P. MD14; Hindryckx, Pieter M. MD, PhD1; Moreels, Tom G. MD, PhD15; Collard, Arnaud MD16; Karlsen, Lars Normann MD17; Kittang, Eirik MD, PhD18; Lambrecht, Guy MD19; Grimstad, Tore MD, PhD17; Koch, Jonas MD20; Lygren, Idar MD, PhD3; Coche, Jean-Claude R.J. MD21; Mana, Fazia MD, PhD22; Van Gossum, André MD, PhD9; Belaiche, Jacques MD, PhD2; Cool, Mike R. MD19; Fontaine, Fernand MD16; Maisin, Jean-Marc G. MD23; Muls, Vinciane MD24; Neuville, Bart MD28; Staessen, Dirk A. J. MD25; Van Assche, Gert A. MD, PhD5; de Lange, Thomas MD, PhD20; Solberg, Inger Camilla MD, PhD3; Vander Cruyssen, Bert J.K. MD, PhD26,27; Vermeire, Severine A.R.A. MD, PhD5

doi: 10.1097/MIB.0b013e31829b2a37
Original Clinical Articles

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.

Article first published online 23 July 2013

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:

The authors have no conflicts of interest to disclose.

Received March 15, 2013

Accepted May 9, 2013

© Crohn's & Colitis Foundation of America, Inc.
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