Consecutive Fecal Calprotectin Measurements to Predict Relapse in Patients with Ulcerative Colitis Receiving Infliximab Maintenance Therapy

Vos, Martine De; Louis, Édouard; Jahnsen, Jørgen; Vandervoort, Jo; Noman, Maja; Dewit, Olivier; D’Haens, Geert R.; Franchimont, Denis; Baert, Filip; Torp, Roald; Henriksen, Magne; Potvin, P; Hootegem, Philippe P Van; Hindryckx, P.; Moreels, Tom G.; Collard, Arnaud; Karlsen, Lars Normann; Kittang, E; Lambrecht, Guy; Grimstad, Tore; Koch, Jonas; Lygren, Idar; Coche, Jean-Claude R J; Mana, Fazia; Gossum, A. Van; Bélaïche, Jacques; Cool, Mike; Fontaine, Fernand; Maisin, Jean-Marc G; Muls, Vinciane; Neuville, B. de; Staessen, Dirk; Assche, Gert A. Van; Lange, Thomas de; Solberg, Inger Camilla; Cruyssen, Bert J K Vander; Vermeire, Séverine

doi:10.1097/mib.0b013e31829b2a37

Cited by 175 publications

(64 citation statements)

References 18 publications

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“…2 Furthermore, a large retrospective cohort of CD patients provided compelling evidence that FC measurement could be used to predict disease course, because FC concentrations were significantly higher in patients with progressive CD than in those without disease progression. 34 De Vos et al 35 recently published a study indicating that two consecutive FC measurements over 300 mg/kg is more specific than a single measurement for predicting relapse in UC patients under maintenance treatment with infliximab. In their study, nearly 80% of the patients in sustained deep remission had at least one FC measurement over 50 mg/kg, similar to our study in which 65% of patients in stable remission had at least one FC measurement over 100 μg/g during the follow-up.…”

Section: Discussionmentioning

confidence: 97%

Does fecal calprotectin predict short-term relapse after stopping TNFα-blocking agents in inflammatory bowel disease patients in deep remission?

Molander

Färkkilä

Ristimäki

et al. 2014

Journal of Crohn's and Colitis

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Section: Discussionmentioning

confidence: 97%

Does fecal calprotectin predict short-term relapse after stopping TNFα-blocking agents in inflammatory bowel disease patients in deep remission?

Molander

Färkkilä

Ristimäki

et al. 2014

Journal of Crohn's and Colitis

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“…Observational studies have described reductions in FC concentration in patients with active UC upon treatment with infliximab 6, 7 , and that FC concentration can predict UC relapse following induction 6 or during maintenance 8 therapy with infliximab. The DEAR Study examined 5-ASA dose escalation in patients with quiescent UC but with an elevated FC concentration.…”

Section: Discussionmentioning

confidence: 99%

Mesalamine Dose Escalation Reduces Fecal Calprotectin in Patients With Quiescent Ulcerative Colitis

Osterman

Aberra

Cross

et al. 2014

Clinical Gastroenterology and Hepatology

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Background & Aims Among patients with quiescent ulcerative colitis (UC), lower fecal concentrations of calprotectin are associated with lower rates of relapse. We performed an open-label, randomized, controlled trial to investigate whether increasing doses mesalamine reduce concentrations of fecal calprotectin (FC) in patients with quiescent UC. Methods We screened 119 patients with UC in remission, based on Simple Clinical Colitis Activity Index scores, FC >50 mcg/g, and intake of no more than 3g/day of mesalamine. Participants taking mesalamine formulations other than multimatrix mesalamine were switched to multimatrix mesalamine (2.4 g/day) for 6 weeks; 52 participants were then randomly assigned (1:1) to a group that continued its current dose of mesalamine (controls, n=26) or a group that increased its dose by 2.4 g/day for 6 weeks (n=26). The primary outcome was continued remission with FC<50 mcg/g. Secondary outcomes were continued remission with FC<100 mcg/g or <200 mcg/g (among patients with pre-randomization values above these levels). Results The primary outcome was achieved by 3.8% of controls and 26.9% of the dose escalation group (P=.0496). More patients in the dose escalation group reduced FC to below 100 mcg/g (P=.04) and 200 mcg/g (P=.005). Among the patients who were still in remission after the randomization phase, clinical relapse occurred sooner in patients with FC >200 mcg/g compared to those with FC <200 mcg/g (P=.01). Conclusion Among patients with quiescent UC and increased levels of FC, increasing the dose of mesalamine by 2.4 g/day reduced fecal concentrations of calprotectin to those associated with lower rates of relapse. Clinicaltrials.gov: NCT00652145

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“…Molander et al [122] reported that a normal fecal calprotectin level after IFX induction could predict sustained clinical remission after 1 year in both CD and UC. For UC patients receiving IFX maintenance therapy, two consecutive measurements of fecal calprotectin [300 mg/kg was identified as the best predictor of relapse [123]. Fecal biomarkers appear to be a convenient and highly correlated tool in evaluating treatment response and long-term prognosis after IFX induction, although more personalized therapeutic dosages and endpoints should be determined in the future [124].…”

Section: Prognosis For Treatment Responsementioning

confidence: 99%

Molecular Analysis of Inflammatory Bowel Disease: Clinically Useful Tools for Diagnosis, Response Prediction, and Monitoring of Targeted Therapy

Jiang

2015

Mol Diagn Ther

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Biomarkers of inflammatory bowel disease (IBD) are non-invasive or minimally invasive tests for IBD diagnosis and/or prognosis as well as assessment of disease activity and response to therapy. Here, we update the current status of IBD biomarkers, including serological, fecal, and genetic (DNA and microRNA [miRNA]) biomarkers. As an update, the classical serological biomarkers, including ASCA, pANCA, anti-OmpC, anti-Cbir, anti-I2, and other anti-glycan antibodies, are discussed only briefly. Emphasis in this article is given to those that have been recently identified or extensively characterized, as well as to the clinical utilities of biomarkers, with special attention to prediction of disease complication and activity assessment, mucosal healing, and response to therapies. In particular, we discuss the utilities of blood-based biomarkers predicting therapeutic response to anti-tumor necrosis factor (TNF)-α, such as anti-anti-TNFα antibodies or anti-drug antibodies (ADA) and trough level of anti-TNFα. Fecal biomarkers, which have recently attracted substantial attention, are also discussed extensively, including the well-characterized calprotectin and lactoferrin, as well as the recently characterized M2-PK, CHI3L1, neopterin, MMP-9, and HMGB1. Genome and exome sequencing enables the discovery of a number of rare yet disease-defining IBD-susceptible genes, particularly those involved in very early onset IBD, providing rare yet extremely useful biomarkers at genetic levels for IBD diagnosis/prognosis. Finally, we briefly summarize the discovery, characterization, and potential implications of miRNA as potential IBD biomarkers.

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Consecutive Fecal Calprotectin Measurements to Predict Relapse in Patients with Ulcerative Colitis Receiving Infliximab Maintenance Therapy

Abstract: Fecal calprotectin can be used in daily practice to monitor patients with UC receiving infliximab maintenance therapy. Two consecutive measurements >300 mg/kg is more specific than a single measurement for predicting relapse.

Cited by 175 publications

References 18 publications

Does fecal calprotectin predict short-term relapse after stopping TNFα-blocking agents in inflammatory bowel disease patients in deep remission?

Does fecal calprotectin predict short-term relapse after stopping TNFα-blocking agents in inflammatory bowel disease patients in deep remission?

Mesalamine Dose Escalation Reduces Fecal Calprotectin in Patients With Quiescent Ulcerative Colitis

Molecular Analysis of Inflammatory Bowel Disease: Clinically Useful Tools for Diagnosis, Response Prediction, and Monitoring of Targeted Therapy

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