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Performance of Common Disease Activity Markers as a Reflection of Inflammatory Burden in Ulcerative Colitis

Brandse, Johannan F. MD, PhD; Bennink, Roel J. MD, PhD; van Eeden, Susanne MD, PhD; Löwenberg, Mark MD, PhD; van den Brink, Gijs R. MD; D'Haens, Geert R. MD

doi: 10.1097/MIB.0000000000000746
Original Clinical Articles

Background: The inflammatory burden influences therapeutic decisions in patients with ulcerative colitis (UC). We aimed to study which commonly used markers of disease activity correlate best with inflammatory burden in patients with UC using leukocyte scintigraphy (single-photon emission computed tomography [SPECT-CT]) as the gold standard.

Methods: Patients with different severity of UC underwent colonoscopy with biopsies and leukocyte SPECT-CT scintigraphy. Serum C-reactive protein (CRP), fecal calprotectin, and clinical questionnaires were collected. The maximum uptake of technetium-labeled leukocytes was calculated as a SPECT score for each colon segment and a summed activity score for 5 colonic segments combined.

Results: Thirty patients with UC were included; 14 of 30 (47%) had left-sided colitis, and 16 of 30 (53%) had pancolitis. One patient (3%) had inactive UC, 5 of 30 (17%) had mild, 11 of 30 (37%) had moderate, and 13 of 30 (43%) had severe disease activity based on the endoscopic Mayo score. The endoscopic Mayo score correlated better with the SPECT score than with the ulcerative colitis endoscopic index of severity (UCEIS) (r = 0.50; P < 0.01 and r = 0.32; P = 0.08, respectively). The Geboes UC histologic score correlated equally well as the Mayo score (r = 0.50; P < 0.01). We found a significant correlation between scintigraphy and fecal calprotectin (r = 0.44; P = 0.02) but not with serum CRP (r = 0.25; P = 0.18). Fecal calprotectin reflected inflammatory burden significantly better in left-sided colitis (r = 0.80; P = 0.001) than in pancolitis (r = 0.22; P = 0.41).

Conclusions: The inflammatory burden in patients with UC, measured by SPECT-CT, is better reflected by the endoscopic Mayo score and the Geboes histologic score than by the UCEIS. Fecal calprotectin is a more accurate inflammatory marker than CRP, predominantly in patients with left-sided colitis.

Registration: This study was approved by the Ethics Committee Review at October 22, 2012 and, in accordance with Dutch legislation, prospectively registered at the CCMO (Dutch central commission for human research) https://www.toetsingonline.nl with NL39801.018.12.

Article first published online 15 March 2016.

Departments of *Gastroenterology and Hepatology,

Nuclear Medicine, and

Pathology, Academic Medical Center, Amsterdam, the Netherlands.

Reprints: Geert R. D'Haens, MD, Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands (e-mail: g.dhaens@amc.uva.nl).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ibdjournal.org).

This study was financially supported by an unrestricted grant from Abbvie. The sponsor did play a role in study design, but did not play a role in collection, analysis, and interpretation of the data and in the writing of the report.

J. F. Brandse has received speakers fees for Takeda, MSD and Abbvie. M. Löwenberg has served as speaker and/or principal investigator for Abbvie, Covidien, Dr. Falk, Ferring Pharmaceuticals, Merck Sharp & Dohme, Receptos, Takeda and Tramedico. He has received research grants from AbbVie, Merck Sharp & Dohme and Achmea healthcare. G. R. van den Brink has received consulting fees from Abbott laboratories and lecture fees from Abbott laboratories, Merck Sharp & Dohme and Ferring Pharmaceuticals. He has received research grants from Abbott laboratories, Crucell and Ferring Pharmaceuticals. G. R. D'Haens has served as a speaker for Abbott Inc, Tillotts, Tramedico, Ferring, MSD, UCB, Norgine, Shire, a consultant for Abbott Laboratories, Actogenix, Centocor, Cosmo, Engene, Ferring Pharmaceuticals, GlaxoSmithKline, Jansen Biologics, Millenium Pharmaceuticals, MSD, Novonordisk, PDL Biopharma, Pfizer, SetPoint, Shire, Takeda, Teva, UCB, and has received research funding from Abbott Inc, Jansen Biologics, Given Imaging, MSD, DrFalk Pharma, Photopill. The remaining authors have no conflict of interest to disclose.

Received December 22, 2015

Accepted January 13, 2016

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