scholarly journals A prospective evaluation of the predictive value of faecal calprotectin in quiescent Crohn's disease

2014 ◽  
Vol 8 (9) ◽  
pp. 1022-1029 ◽  
Author(s):  
Graham D. Naismith ◽  
Lyn A. Smith ◽  
Sarah J.E. Barry ◽  
Joanna I. Munro ◽  
Susan Laird ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Primary Endpoint ◽  
Roc Curve ◽  
Predictive Value ◽  
Clinical Relapse ◽  
Optimal Cutoff ◽  
Faecal Calprotectin ◽  
Kaplan Meier ◽  
Time To Relapse

Abstract Background Faecal calprotectin (FC) is a non-invasive marker of gastrointestinal inflammation. Aim To determine whether higher FC levels in individuals with quiescent Crohn's disease are associated with clinical relapse over the ensuing 12 months. Methods A single centre prospective study was undertaken in Crohn's disease patients in clinical remission. The receiver operating characteristic (ROC) curve for the primary endpoint of clinical relapse by 12 months, based on FC at baseline, was calculated. Kaplan–Meier curves of time to relapse were based on the resulting optimal FC cutoff for predicting relapse. Results Of 97 patients recruited, 92 were either followed up for 12 months without relapsing, or reached the primary endpoint within that period. Of these, 10 (11%) relapsed by 12 months. Median FC was lower for non-relapsers, 96 μg/g (IQR 39–237), than for relapsers, 414 μg/g (IQR 259–590), (p = 0.005). The area under the ROC curve to predict relapse using FC was 77.4%. An optimal cutoff FC value of 240 μg/g to predict relapse had sensitivity of 80.0% and specificity of 74.4%. Negative predictive value was 96.8% and positive predictive value was 27.6%, FC ≥ 240 μg/g was associated with likelihood of relapse by 12-months 12.18 (95%CI 2.55–58.2) times higher than lower values (p = 0.002). Conclusions In this prospective dataset, FC is a useful tool to help identify quiescent Crohn's disease patients at a low risk of relapse over the ensuing 12 months. FC of 240 μg/g was the optimal cutoff in this cohort.

scholarly journals P163 FAECAL CALPROTECTIN IS A PREDICTIVE MARKER OF CLINICAL RELAPSE IN CROHN'S DISEASE

2008 ◽  
Vol 2 (1) ◽  
pp. 54
Author(s):  
L. Kallel ◽  
N. Ben Mahmoud ◽  
M. Feki ◽  
I. Ayadi ◽  
S. Matri ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Predictive Marker ◽  
Clinical Relapse ◽  
Faecal Calprotectin

scholarly journals P343 Maintenance of deep remission in Crohn’s disease after switching from anti–TNF to ustekinumab

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S366-S367
Author(s):  
G Mantzaris ◽  
M Vraka ◽  
H Beka ◽  
T Georgiadi ◽  
F Albani ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Lupus Erythematosus ◽  
De Novo ◽  
Right Hemicolectomy ◽  
Preventive Therapy ◽  
Considerable Proportion ◽  
Clinical Relapse ◽  
Faecal Calprotectin ◽  
Endoscopic Recurrence

Abstract Background Anti-TNF agents, infliximab (IFX) and adalimumab (ADL) are first line treatment for moderate-to-severe Crohn’s disease (CD) and for preventing post-operative recurrence of CD (CD-POR) following right hemicolectomy (RH). However, a considerable proportion of patients develop allergic reactions and/or paradoxical inflammation to anti-TNFs necessitating switching to out of class biologic despite deep remission. We aimed to assess whether ustekinumab (UST), an IL12/IL23 inhibitor, can maintain deep remission in these patients. Methods This prospective, single centre study enrolled CD patients with B1 phenotype or on POR preventive therapy who were in prolonged deep remission when became intolerable of anti-TNFs. Deep remission was defined as clinical (HBI<4), biomarker (normal CRP and faecal calprotectin [FC<150μg/dl]), and endoscopic remission (SES-CD≤2 or Rutgeerts’ score [RS]≤1). Patients received UST (6mg/kg iv followed by 90mg sc q8 weeks) and were followed every 2 months with HBI score calculation and routine laboratory tests. Ileocolonoscopy was performed at 1y after UST initiation and the SES-CD or the RS were calculated. Absence of deep remission was defined as clinical (HBI>5), or biomarker relapse or endoscopic recurrence (SES-CD>2 or RS≥2, respectively). Results Twenty five patients (15 males), median age(range) 42(20-65)y were included. Seven patients had undergone RH, 6 had colitis and 12 had ileitis or ileocolitis; 13 patients had received ADL, 8 IFX and 4 both. Patients were in deep remission for 3.8 (2-10)y [median (range)]. Reasons for switching were severe psoriasis/proriasiform lesions (11), persistent arthralgias (10), infusion/injection reactions (2), anti-TNF-induced lupus erythematosus (2), sweet syndrome (1), and vasculitis (1). Two patients had more than one paradoxical inflammation. At baseline the median (range) CRP was 0.21mg/dl (0.10-0.40), FC 52μg/g (20-114). Trough levels for anti-TNFs in 15/25 patients were normal without antibodies. At 1-year post-switching endoscopic CD-POR was seen in 3/7 patients (RS≥2b) associated with biomarker relapse in 2 and clinical relapse in 1 patient. Of 18 patients with B1 phenotype deep remission was maintained in 15: two patients with infusion reactions to IFX relapsed and 1 patient developed endoscopic lesions in view of normal CRP but abnormal FC (SES-CD 6, 5 and 3, respectively). Paradoxical inflammation resolved in all 23 patients but de novo arthralgias developed in 2 patients. Thus, one year after switching to UST, 19/25 CD patients maintained deep remission. Conclusion UST seems to be a reliable therapeutic alternative for anti-TNF-dependent patients who have who cannot tolerate anti-TNFs.

scholarly journals PTH-078 A Prospective Evaluation of the Predictive Value of Faecal Calprotectin in Quiescent Crohn’S Disease

Gut ◽  
2013 ◽  
Vol 62 (Suppl 1) ◽  
pp. A242.3-A243
Author(s):  
L A Smith ◽  
G Naismith ◽  
S Barry ◽  
J I Munro ◽  
S Laird ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Predictive Value ◽  
Prospective Evaluation ◽  
Faecal Calprotectin

Tu1111 A Prospective Evaluation of the Predictive Value of Faecal Calprotectin in Quiescent Crohn's Disease

2013 ◽  
Vol 144 (5) ◽  
pp. S-765
Author(s):  
Lyn A. Smith ◽  
Graham Naismith ◽  
Sarah Barry ◽  
Karen Rankin ◽  
Joanna I. Munro ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Predictive Value ◽  
Prospective Evaluation ◽  
Faecal Calprotectin

P302 A prospective evaluation of the predictive value of faecal calprotectin in quiescent Crohn's disease

2013 ◽  
Vol 7 ◽  
pp. S129-S130
Author(s):  
L.A. Smith ◽  
G. Naismith ◽  
S. Barry ◽  
K. Rankin ◽  
J. Munro ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Predictive Value ◽  
Prospective Evaluation ◽  
Faecal Calprotectin

scholarly journals Relevance of monitoring transmural disease activity in patients with Crohn’s disease: current status and future perspectives

2021 ◽  
Vol 14 ◽  
pp. 175628482110066
Author(s):  
Rune Wilkens ◽  
Kerri L. Novak ◽  
Christian Maaser ◽  
Remo Panaccione ◽  
Torsten Kucharzik
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Symptom Control ◽  
Current Status ◽  
Clinical Relapse ◽  
Cross Sectional ◽  
Treatment Targets ◽  
Endoscopic Remission ◽  
Transmural Inflammation

Treatment targets of inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn’s disease (CD) have evolved over the last decade. Goals of therapy consisting of symptom control and steroid sparing have shifted to control of disease activity with endoscopic remission being an important endpoint. Unfortunately, this requires ileocolonoscopy, an invasive procedure. Biomarkers [C-reactive protein (CRP) and fecal calprotectin (FCP)] have emerged as surrogates for endoscopic remission and disease activity, but also have limitations. Despite this evolution, we must not lose sight that CD involves transmural inflammation, not fully appreciated with ileocolonoscopy. Therefore, transmural assessment of disease activity by cross-sectional imaging, in particular with magnetic resonance enterography (MRE) and intestinal ultrasonography (IUS), is vital to fully understand disease control. Bowel-wall thickness (BWT) is the cornerstone in assessment of transmural inflammation and BWT normalization, with or without bloodflow normalization, the key element demonstrating resolution of transmural inflammation, namely transmural healing (TH) or transmural remission (TR). In small studies, achievement of TR has been associated with improved long-term clinical outcomes, including reduced hospitalization, surgery, escalation of treatment, and a decrease in clinical relapse over endoscopic remission alone. This review will focus on the existing literature investigating the concept of TR or residual transmural disease and its relation to other existing treatment targets. Current data suggest that TR may be the next logical step in the evolution of treatment targets.

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