Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn’s disease patients

Abstract

BACKGROUNDAsymptomatic children with Crohn’s disease (CD) require ongoing monitoring to ensure early recognition of a disease exacerbation.AIMIn a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease relapse.METHODSIn this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn’s Disease Activity Index, C-reactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 mo.RESULTS53 children were included and eighteen patients (34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median (interquartile range), relapse 723 μg/g (283-1758) vs 244 μg/g (61-627), P = 0.02]. Fecal calprotectin levels > 250 μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo (area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).CONCLUSIONRoutine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.

STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD

“…Low CRP values are associated with reduced risk of clinical relapse, with AUC of 0.70 to 0.72. [19][20][21][22] On the other side, high CRP values determined at time of anti-TNF discontinuation are associated with higher risk of relapse. 23,24 CRP normalization at 8 to 14 weeks after treatment predicts remission at 1 year, 14,25,26 as well as anti-TNF success at 2 years.…”

Cathelicidin – A Novel Potential Marker of Pediatric Inflammatory Bowel Disease

“… 41 Fecal calprotectin has been found as a highly sensitive and moderately specific marker of IBD in children. 42 , 43 Elevated level of calprotectin has been also reported to predict relapse of IBD, 40 , 44 while its low levels correlate with endoscopic mucosal healing in patients with IBD. 45 …”

“…Calprotectin (S100A8/9) is a zinc- and calcium-binding cytosolic protein which is released from neutrophils upon their activation as a consequence of inflammation. 40 Thus, the amount of calprotectin in feces reflects the flux of leukocytes into the intestinal lumen. 41 Fecal calprotectin has been found as a highly sensitive and moderately specific marker of IBD in children.…”

Albumin-to-Globulin Ratio at 1 Year after Anti-Tumor Necrosis Factor α Therapy Can Serve as a Prognostic Biomarker in Pediatric Crohn’s Disease Patients

“…To the best of our knowledge, this is the first study on predictors associated with relapse during anti-TNF-α therapy in pediatric patients with CD except for calprotectin. 22 Despite an effective treatment that enables remission to be reached, a degree of subclinical inflammation may remain within the gastrointestinal tract, contributing to a risk of clinical relapse in some patients with CD. 6,8 Unfortunately, it is difficult to predict if there will be a relapse and when it will occur.…”