Background:Anastomotic recurrence is frequent in patients with Crohn’s disease (CD)
following ileocecal resection. The degree of endoscopic recurrence,
quantified by the Rutgeerts score (RS), correlates with risk of clinical and
surgical recurrence. Several studies demonstrate the accuracy of fecal
calprotectin (FC) for detection of endoscopic recurrence, however the
optimal threshold FC value remains to be established. The aim of our
meta-analysis was to evaluate the accuracy of common FC cut-offs for
detection of endoscopic recurrence.Methods:We performed a systematic literature search for studies evaluating
postoperative recurrence in CD which reported RS and FC levels. Endoscopic
recurrence was defined as RS = 2–4 (or RS ⩾ 2). We calculated pooled
diagnostic sensitivity, specificity, diagnostic odds ratio (DOR) and
constructed summary receiver operating characteristic (SROC) curves for each
available FC cut-off value.Results:A total of 54 studies were retrieved; 9 studies were eligible for analysis.
Diagnostic accuracy was calculated for FC values of 50, 100, 150 and 200
µg/g. A significant threshold effect was observed for all FC values. The
optimal diagnostic accuracy was obtained for FC value of 150 µg/g, with a
pooled sensitivity of 70% [95% confidence interval (CI) 59–81%], specificity
69% (95% CI 61–77%), and DOR 5.92 (95% CI 2.61–12.17). The area under the
SROC curve was 0.73.Conclusion:FC is an accurate surrogate marker of postoperative endoscopic recurrence in
CD patients. The FC cut-off 150 μg/g appears to have the best overall
accuracy. Serial FC evaluations may eliminate or defer the need for
colonoscopic evaluation in up to 70% of postoperative CD patients.
Seventy-three consecutive patients (32-infliximab, 41-adalimumab) were included in the study. The colonoscopies were performed after a median of 15 (7-43) months after surgery and 8 (6-15) months from treatment onset. SER was demonstrated in 26/73 (35.6%) of the patients. The need for dose optimization, as well as trough infliximab levels (2.4 μg/mL [0.45-4.1] versus 1.1 (0-0.6), P = 0.008) and presence of antidrug antibodies (1/18 [5.6%] versus 10/14 [71.4%], P = 0.0001) were significantly associated with a risk of SER. The optimal cutoff infliximab level for prediction of SER was 1.8 μg/mL. No association between adalimumab levels and antiadalimumab antibodies was demonstrated.
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