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

Abstract

BACKGROUND AND AIMS:

This prospective multicenter study examined whether elevated fecal calprotec tin (FC) concentrations after stopping TNFα-blocking therapy can predict clinical or endoscopic relapse. In addition, we evaluated the impact of histological remission on the relapse risk.

METHODS:

We enrolled inflammatory bowel disease (IBD) patients who were in clinical, endoscopic, and FC-based (< 100 μg/g) remission after a minimum 11 months of TNFα-blocking therapy. The patients were followed-up for 12 months after the discontinuation of TNFα-blocking therapy. FC was collected monthly for the first 6 months and thereafter every second month. Ileocolonoscopy was performed at inclusion, at 4 months, at the study end, and at the time of clinical relapse.

RESULTS:

Of 52 enrolled patients, 49 (16 Crohn's disease, 33 ulcerative colitis/IBD unclassified) provided the stool samples requested and comprised the study group. During the follow-up, 15/49 (31%) relapsed, whereas 34 (69%) remained in remission. Patients relapsing showed constantly elevated FC levels for a median of 94 (13-317) days before the relapse. Significant increase in median FC levels was seen 2 (p = 0.0014), 4 (p = 0.0056), and 6 (p = 0.0029) months before endoscopic relapse. Constantly normal FC concentrations during the follow-up were highly predictive for clinical and endoscopic remission. Normal FC concentrations in patients with remission were associated with histological remission.

CONCLUSION:

FC seems to increase and remain elevated before clinical or endoscopic relapse, suggesting that it can be used as a surrogate marker for predicting and identifying patients requiring close follow-up in clinical practice.

• Authors: Pauliina Molander, Martti Färkkilä, Ari Ristimäki, Kimmo Salminen, Helena Kemppainen, Timo Blomster, Ritva Koskela, Airi Jussila, Henna Rautiainen, Markku Nissinen, Johanna Haapamäki, Perttu Arkkila, Urpo Nieminen, Juha Kuisma, Jari Punkkinen, Kaija-Leena Kolho, Harri Mustonen, Taina Sipponen
• Journal: Journal of Crohn's & colitis (J Crohns Colitis) Vol. 9 Issue 1 Pg. 33-40 (Jan 2015) ISSN: 1876-4479 [Electronic] England
• PMID: 25052347 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Gastrointestinal Agents
• Leukocyte L1 Antigen Complex
• Tumor Necrosis Factor-alpha

Topics

• Adolescent
• Adult
• Child
• Colonoscopy
• Enzyme-Linked Immunosorbent Assay
• Feces (chemistry)
• Female
• Follow-Up Studies
• Gastrointestinal Agents (therapeutic use)
• Humans
• Inflammatory Bowel Diseases (diagnosis, drug therapy, metabolism)
• Leukocyte L1 Antigen Complex (analysis)
• Male
• Middle Aged
• Prognosis
• Recurrence
• Remission Induction
• Time Factors
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Young Adult