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.
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.
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).
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: email@example.com).
The authors have no conflicts of interest to disclose.
Received March 15, 2013
Accepted May 9, 2013