Biomarker-Based Models Outperform Patient-Reported Scores in Predicting Endoscopic Inflammatory Disease Activity

Morris, Marc; Stewart, Samuel Alan; Heisler, Courtney; Sandborn, William J.; Loftus, Edward V.; Zello, Gordon A.; Fowler, Sharyle; Jones, Jennifer

doi:10.1093/ibd/izx018

Cited by 17 publications

(21 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this analysis, multivariate logistic regression showed no significant contribution of CDAI in prediction of endoscopic outcomes; this finding is supported by recent evidence that CDAI may not provide sufficient correlation with endoscopic scores and that the addition of biomarkers provides better predictive accuracy than CDAI alone. 27 , 28 …”

Section: Discussionmentioning

confidence: 99%

Association of Biomarker Cutoffs and Endoscopic Outcomes in Crohn’s Disease: A Post Hoc Analysis From the CALM Study

Reinisch

Panaccione

Bossuyt

et al. 2020

Inflammatory Bowel Diseases

Self Cite

View full text Add to dashboard Cite

Background CALM was a randomized phase 3 trial in patients with Crohn’s disease (CD) that demonstrated improved endoscopic outcomes when treatment was escalated based on cutoffs for inflammatory biomarkers, fecal calprotectin (FC), C-reactive protein (CRP), and CD Activity Index (CDAI) remission vs CDAI response alone. The purpose of this post hoc analysis of CALM was to identify drivers of treatment escalation and evaluate the association between biomarker cutoff concentrations and endoscopic end points. Methods The proportion of patients achieving CD Endoscopic Index of Severity (CDEIS) <4 and no deep ulcers 48 weeks after randomization was evaluated according to CRP <5 mg/L or ≥5 mg/L and FC <250 μg/g or ≥250 μg/g. Subgroup analyses were performed according to disease location, and sensitivity analyses were conducted in patients with elevated CRP and/or FC at baseline. The association between endoscopic end points and biomarker cutoffs was performed using χ 2 test. Results The proportion of patients who achieved the primary end point CDEIS <4 and no deep ulcers was significantly greater for those with FC <250 µg/g (74%; P < 0.001), with an additive effect for CRP <5 mg/L. The association of FC <250 µg/g with improved endoscopic outcomes was independent of disease location, although the greatest association was observed for ileocolonic disease. Fecal calprotectin <250 µg/g, CRP <5 mg/L, and CDAI <150 gave a sensitivity/specificity of 72%/63% and positive/negative predictive values of 86%/42% for CDEIS <4 and no deep ulcers 48 weeks after randomization. Conclusion This post hoc analysis of CALM demonstrated that a cutoff of FC <250 µg/g is a useful surrogate marker for mucosal healing in CD.

show abstract

Section: Discussionmentioning

confidence: 99%

Association of Biomarker Cutoffs and Endoscopic Outcomes in Crohn’s Disease: A Post Hoc Analysis From the CALM Study

Reinisch

Panaccione

Bossuyt

et al. 2020

Inflammatory Bowel Diseases

Self Cite

View full text Add to dashboard Cite

show abstract

“…Biomarkers have been used to detect EE and other gastrointestinal diseases, such as biliary atresia and inflammatory bowel disease. 42 , 43 , 44 , 45 , 46 , 47 , 48 However, to our knowledge, there has been no work on estimating or synthesizing biopsies from biomarkers.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Machine Learning Detection of Environmental Enteropathy and Celiac Disease in Children

et al. 2019

View full text Add to dashboard Cite

Key Points Question Can deep learning image analysis distinguish pathological vs healthy features in duodenal tissue? Findings In this diagnostic study, a deep learning convolutional neural network was trained on 3118 images from duodenal biopsies of patients with environmental enteropathy, celiac disease, and no disease. The convolutional neural network achieved 93.4% case-detection accuracy, with a false-negative rate of 2.4%, and automatically learned microlevel features in duodenal tissue, such as alterations in secretory cell populations. Meaning A machine learning–based feature detection platform distinguished pathological from healthy tissue in gastrointestinal biopsy images.

show abstract

“…Subsequent studies analysing FCAL as a surrogate marker of IBD activity were in agreement with the findings of these two meta-analyses. However, the previous results do not eliminate the prognostic value of patient's symptoms to estimate the endoscopic activity of IBD, and despite FCAL being a better surrogate marker of endoscopic inflammatory activity than CRP and patientreported outcomes (PRO), a combination of PRO and FCAL has resulted in increased AUROC compared to FCAL alone [37].…”

Section: Utility Of Fcal To Monitor Disease Activity In Ibdmentioning

confidence: 90%

Faecal calprotectin in inflammatory bowel diseases: a review focused on meta-analyses and routine usage limitations

Laserna-Mendieta

Lucendo

2019

Clinical Chemistry and Laboratory Medicine (CCLM)

View full text Add to dashboard Cite

A growing body of evidence has been published about the usefulness of measuring calprotectin in faecal samples (FCAL) in inflammatory bowel disease (IBD) assessment, including diagnosis, monitoring of disease activity and relapse prediction. Several systematic reviews with meta-analyses compiling studies for each particular clinical setting have been carried out in recent years. Most of these were focused on the use of FCAL in IBD diagnosis and showed a relevant role for this marker in selecting patients with gastrointestinal symptoms who would not need a further examination by endoscopy. Although a lesser number of meta-analyses have been performed on the use of FCAL as a surrogate marker of disease activity, a close correlation between FCAL and endoscopic activity of IBD has been shown. With respect to the predictive capacity of FCAL for IBD relapse, a single meta-analysis published indicates that this role is more limited. Furthermore, FCAL thresholds vary considerably depending on the clinical setting and, what is more concerning, among different commercially available assays due to a lack of FCAL concentration interchangeability. Here, we summarise recent publications about the role and limitations of FCAL in IBD, with a special focus on meta-analyses, and give an overview of alternative faecal biomarkers.

show abstract

Biomarker-Based Models Outperform Patient-Reported Scores in Predicting Endoscopic Inflammatory Disease Activity

Abstract: The inclusion of biomarkers significantly improved predictive accuracy for endoscopic disease activity compared with PRO-exclusive models.

Cited by 17 publications

References 39 publications

Association of Biomarker Cutoffs and Endoscopic Outcomes in Crohn’s Disease: A Post Hoc Analysis From the CALM Study

Association of Biomarker Cutoffs and Endoscopic Outcomes in Crohn’s Disease: A Post Hoc Analysis From the CALM Study

Assessment of Machine Learning Detection of Environmental Enteropathy and Celiac Disease in Children

Faecal calprotectin in inflammatory bowel diseases: a review focused on meta-analyses and routine usage limitations

Contact Info

Product

Resources

About