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Inflammatory Bowel Diseases:
Original Clinical Articles
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
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.
© Crohn's & Colitis Foundation of America, Inc.
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ulcerative colitis, fecal calprotectin, relapse, remission, infliximab, marker, maintenance therapy
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