Buisson A^1,2,3, Mak WY^1,4, Andersen MJ Jr¹, Lei D¹, Kahn SA¹, Pekow J¹, Cohen RD¹, Zmeter N¹, Pereira B⁵, Rubin DT¹. J Crohns Colitis. 2019 Feb 6. doi: 10.1093/ecco-jcc/jjz023. [Epub ahead of print]

Author information

1 Inflammatory Bowel Disease Center University of Chicago Medicine, Chicago, Illinois, United States of America.

2 Université Clermont Auvergne, Inserm, CHU Clermont-Ferrand, 3iHP, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.

3 Université Clermont Auvergne, 3iHP, Inserm, M2iSH, USC-INRA, Clermont-Ferrand, France.

4 Department of Medicine, Queen Elizabeth Hospital, Hong Kong.

5 Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand, France.

Abstract

BACKGROUND AND AIMS: To assess faecal calprotectin (Fcal) levels before and after therapeutic de-escalation to predict clinical relapse in patients with inflammatory bowel disease (IBD).

METHODS: From a prospectively-maintained database, we enrolled 160 IBD patients (112 Crohn's disease/48 ulcerative colitis) in clinical remission, with Fcal measured within 8 weeks before therapeutic de-escalation. Clinical relapse was defined using Harvey-Bradshaw index or simple clinical colitis activity index.

RESULTS: Using a ROC curve, Fcal >100 µg/g was the best threshold to predict clinical relapse after therapeutic de-escalation (AUC=0.84). In multivariate analysis, clinical remission >6 months before therapeutic de-escalation (Hazard ratio (HR)=0.57[0.33-0.99]; p=0.044) was associated with decreased risk of relapse while current steroids medication (HR=1.67[1.00-2.79]; p<0.0001) was a risk factor. Fcal >100 µg/g was predictive of clinical relapse (HR=3.96[2.47-6.35]; p<0.0001) in the whole cohort but also in patients with anti-TNF agents (n=85 patients; p<0.0001), anti-integrins (n=32; p=0.003), no biologics (n=43; p=0.049) or attempting to discontinue steroids (n=37; p=0.001). One patient (1/98) and 7 patients (7/88, 8.0%) with baseline Fcal <100 µg/g relapsed within 3 months and 6 months after therapeutic de-escalation, respectively. Seventy-Four Fcal measurements were performed in 52 patients after therapeutic de-escalation. Monitoring Fcal >200 µg/g (ROC curve with AUC=0.96) was highly predictive of clinical relapse in multivariate analysis (HR=31.8[3.5-289.4], p=0.002). Only two relapses (2/45, 4.4%) occurred within 6 months while Fcal< 200 µg/g.

CONCLUSION: Fcal level is highly accurate to predict and monitor the risk of relapse after therapeutic de-escalation in IBD patients and could be used in daily practice