Prediction of Crohn’s disease relapse with faecal calprotectin in infliximab responders: a prospective study

• Published in: Alimentary pharmacology & therapeutics Vol. 34; no. 4; pp. 462 - 469
• Main Authors: Laharie, D., Mesli, S., El Hajbi, F., Chabrun, E., Chanteloup, E., Capdepont, M., Razaire, S., de Lédinghen, V., Zerbib, F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2011; Blackwell; Wiley
• Subjects: Adolescent; Adult; Aged; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Biomarkers - metabolism; Crohn Disease - diagnosis; Crohn Disease - drug therapy; Crohn Disease - metabolism; Digestive system; Feces - chemistry; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Agents - therapeutic use; Humans; Infliximab; Leukocyte L1 Antigen Complex - metabolism; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pharmacology. Drug treatments; Predictive Value of Tests; Prospective Studies; Recurrence; Regression Analysis; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Tumor Necrosis Factor-alpha - therapeutic use; Young Adult; Relapse; Cytokine; Antipsoriatic agent; Prediction; Monoclonal antibody; Anti-Tumor Necrosis Factor-alpha; Inflammatory disease; Immunomodulator; Prospective; Crohn disease; Infliximab; Anticytokine; Digestive diseases; Intestinal disease; Calprotectin; Feces; Immunosuppressive agent; Predictive factor; Tumor necrosis factor α; Medicine
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2011.04743.x

Aliment Pharmacol Ther 2011; 34: 462–469 Summary Background  Faecal calprotectin is a reliable tool for predicting Crohn’s disease (CD) relapse in patients with sustained remission. Prediction of relapse with faecal calprotectin has been less studied in patients with severe CD treated with anti‐TNF. Aim  To identify an association between faecal calprotectin concentration and CD clinical relapse in patients achieving remission with infliximab (IFX). Methods  From February 2007 to October 2008, consecutive patients with refractory luminal CD were prospectively included when they received three IFX infusions (5 mg/kg at weeks 0, 2 and 6) followed by maintenance with an immunomodulator alone. Faecal calprotectin and C‐reactive protein (CRP) were measured at entry and at week 14 (w14). Results  Sixty‐five patients (43W; median age: 30.4 years) were included, and 50 (77%) were in clinical remission off steroids at w14; twenty‐three of fifty (46%) experienced CD clinical relapse during the first year of follow‐up. Median faecal calprotectin level at w14 was similar in patients with and without CD clinical relapse (200 and 150 μg/g respectively). When considering two suggested faecal calprotectin cut‐offs to predict CD relapse, sensitivities and specificities were 61% and 48% for 130 μg/g, respectively, and 43% and 57% for 250 μg/g. Neither faecal calprotectin nor CRP at baseline and at w14 could predict relapse even when CD location subgroup analysis was considered. Conclusion  In patients responding to an infliximab induction regimen, faecal calprotectin measurement at w14 cannot predict Crohn’s disease clinical relapse at 1 year.