Diagnostic importance of faecal markers in long-term monitoring of anti-TNF- therapy in primary responders with Crohn’s disease

Abstract

IntroductionMonitoring the response to biological treatment in Crohn’s disease (CD) is a very important element of the therapeutic optimisation.AimTo evaluate the usefulness of measuring calprotectin, lactoferrin, and myeloperoxidase in stool as markers of long-term clinical and endoscopic response to anti-tumour necrosis factor α (anti-TNF) treatment in CD.Material and methodsThe studied group consisted of 35 CD patients treated with anti-TNF-α antibodies. Clinical activity was evaluated using Crohn’s Disease Activity Index (CDAI), and the exacerbation of endoscopic changes was evaluated using a Simple Endoscopic Score for Crohn’s Disease (SES-CD). The concentration of calprotectin, lactoferrin, and myeloperoxidase was measured using the ELISA method. All measurements were performed three times – before, after 3 months, and after a year of therapy.ResultsDuring anti-TNF treatment the concentrations of all measured faecal markers decreased significantly in relation to baseline values. We observed a significant correlation at all time-points: before the therapy, after 3 months, and 12 months after starting the therapy, between the concentration of calprotectin and SES-CD, calprotectin and CDAI, as well as between lactoferrin and SES-CD, and lactoferrin and CDAI. Myeloperoxidase correlated with both SES-CD and CDAI only after 1 year of treatment.ConclusionsFaecal calprotectin and lactoferrin are valuable markers of clinical and endoscopic activity of CD in patients treated with anti-TNF antibodies. They are useful in monitoring the response to treatment. The usefulness of myeloperoxidase in this respect remains controversial.

Is fecal calprotectin an accurate marker in the management of Crohn's disease?

“…Repeated measurement of FC indicates that a drop of pretreatment stool concentration is effective in predicting response to anti‐tumor necrosis factor‐α antibodies. Again, differing reduction values versus baseline were used for predicting favorable responses (Table ) …”

“…Again, differing reduction values versus baseline were used for predicting favorable responses (Table 4). [36][37][38][39][40][41][42][43][44] Conversely, minor reductions of FC (< 70%) after anti-tumor necrosis factor-α antibodies induction predict non-response. 42 14 50 μg/g 59 71 --P = 0.008 Sipponen 2012 29 14 100 μg/g 36 89 --P = 0.008 Höög 2014 26 30 ---Lewis score Inclusion r = 0.54 Inclusion P = 0.003 Höög 2014 26 30 ---Lewis score Follow-up r = 0.83 Follow-up P < 0.001 Egea-Valenzuela 2015 25 68 50 μg/g 96 23 Lewis score r 2 = 0.1 -Egea-Valenzuela 2015 25 34 100 μg/g 75 67…”

“…39 All these studies but one 44 were prospective, but some limitations result from the small number of enrolled patients, exceeding 35 patients in only one case 44 (Table S1). Moreover, five out of 10 studies 38,40,[42][43][44] took into consideration only clinical relapse assessed according to CDAI or Harvey-Bradshaw index, reducing the accuracy in the absence of endoscopic evaluations.…”

“…Several studies carried out on small series of CD patients all support the concept that the measurement of FC helps to predict the response to treatment . This information applies to biological therapies, as the data on traditional drugs are not available.…”

Does the rapid fecal calprotectin test equally predict mucosal inflammation in both ulcerative colitis (UC) and Crohn’s disease (CD)? A prospective analysis of an IBD cohort

“…This biomarker may be adapted in biolog ical therapy monitoring, which is nowadays com monly used in IBD care in Poland. [21][22][23] It has been shown that FC elevation predicts short term re lapse after discontinuation of antitumor necrosis factor α therapy in patients with IBD in deep re mission. 24 Moreover, in the POCER study, Wright et al 25 found that FC elevation predicted early postoperative recurrence in patients with CD.…”