Tight control using fecal calprotectin and early disease intervention increase the rates of transmural remission in Crohn's disease

• Published in: United European gastroenterology journal Vol. 12; no. 4; pp. 451 - 458
• Main Authors: Fernandes, Samuel Raimundo, Bernardo, Sónia, Saraiva, Sofia, Gonçalves, Ana Rita, Moura Santos, Paula, Valente, Ana, Correia, Luís Araújo, Cortez‐Pinto, Helena, Magro, Fernando
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01.05.2024
• Subjects: Adult; Biomarkers - analysis; Colonoscopy; Crohn Disease - diagnosis; Crohn Disease - drug therapy; Crohn Disease - metabolism; Crohn's disease; fecal calprotectin; Feces - chemistry; Female; Humans; Inflammatory Bowel Disease; Leukocyte L1 Antigen Complex - analysis; Magnetic Resonance Imaging; Male; Middle Aged; Original; Remission Induction; Retrospective Studies; transmural remission; Treatment Outcome; Young Adult; Crohn's disease; fecal calprotectin; inflammatory bowel disease; transmural remission
• ISSN: 2050-6406; 2050-6414; 2050-6414
• DOI: 10.1002/ueg2.12497

Background Increasing evidence supports the use of transmural remission as a treatment target in Crohn's disease (CD), but it is seldom achieved in clinical practice. Tight monitoring of inflammation using fecal calprotectin with reactive treatment escalation may potentially improve these results. Aims To evaluate if treatment escalation based on fecal calprotectin can improve the rates of transmural remission in CD. The influence of the timing of intervention on this strategy was also evaluated. Methods Retrospective cohort study including 256 CD patients with 2 consecutive assessments by MRI‐enterography and colonoscopy and with regular monitoring using fecal calprotectin. For each occurrence of an elevated fecal calprotectin (≥250 μg/g), we evaluated whether a reactive adjustment of medical treatment was performed. The ratio of treatment escalation/elevated fecal calprotectin was correlated with the chances of reaching transmural remission. Early disease was defined as disease duration <18 months without previous exposure to immunomodulators and biologics. Results After a median follow‐up of 2 years (IQR 1–4), 61 patients (23.8%) reached transmural remission. Ratios of escalation ≥50% resulted in higher rates of transmural remission (34.2% vs. 15.1%, p < 0.001). The effect was more pronounced in patients with early disease (50.0% vs. 12.0%, p = 0.003). In multivariate analysis, a treatment escalation ratio ≥50% (OR 3.46, 95% CI 1.67–7.17, p = 0.001) and early disease intervention (OR 3.24, 95% CI 1.12–9.34, p = 0.030) were independent predictors of achieving transmural remission. Conclusion Tight‐monitoring and reactive treatment escalation increase the rates of transmural remission in CD. Intervention in early disease further improves these results. Tight control using fecal calprotection and early disease intervention increase the rates of transmural remission in Crohn’s disease.