Fecal Calprotectin Assay at an Early Stage of Treatment Can Be Used as a Surrogate Marker to Predict Clinical Remission and Mucosal Healing in Pediatric Crohn’s Disease
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Purpose: This study evaluated the predictive role of fecal calprotectin (FC) measured at an early stage of treatment for monitoring clinical remission (CR) after six months and endoscopic remission (ER) after one year of treatment in pediatric Crohn’s disease (CD). Methods: This retrospective study included 45 patients who simultaneously underwent ileocolonoscopy and FC testing during follow-up. FC levels were measured before and after six weeks of treatment. CR was assessed after six months of treatment using Pediatric Crohn’ s Disease Activity Index and acute-phase reactants. ER was assessed after one year using the Simple Endoscopic Score for Crohn’s Disease. Results: Twenty-nine (64.4%) patients used oral prednisolone for remission induction and 16 (35.6%) patients used anti-tumor necrosis factor-alpha. Thirty (66.7%) patients achieved CR, while 24 (53.3%) achieved ER. The FC level measured after six weeks of treatment could predict CR (χ2=9.15, p=0.0025) and ER (χ2=12.31, p=0.0004). The δFC could predict CR (χ2=7.91, p=0.0049), but not ER (χ2=1.85, p=0.1738). With a threshold of ≤950.4 μg/g, FC at week six could predict CR with 76.7% sensitivity and 73.3% specificity. The area under the curve (AUC) was 0.769 (standard error 0.0773, p=0.0005). The same threshold predicted ER with 87.5% sensitivity and 71.4% specificity. The AUC was 0.774 (standard error 0.074, p=0.0002). Conclusion: FC assay at an early stage of treatment can be used as a surrogate marker to predict CR and mucosal healing in pediatric CD.
Abstract
Purpose: This study evaluated the predictive role of fecal calprotectin (FC) measured at an early stage of treatment for monitoring clinical remission (CR) after six months and endoscopic remission (ER) after one year of treatment in pediatric Crohn’s disease (CD). Methods: This retrospective study included 45 patients who simultaneously underwent ileocolonoscopy and FC testing during follow-up. FC levels were measured before and after six weeks of treatment. CR was assessed after six months of treatment using Pediatric Crohn’ s Disease Activity Index and acute-phase reactants. ER was assessed after one year using the Simple Endoscopic Score for Crohn’s Disease. Results: Twenty-nine (64.4%) patients used oral prednisolone for remission induction and 16 (35.6%) patients used anti-tumor necrosis factor-alpha. Thirty (66.7%) patients achieved CR, while 24 (53.3%) achieved ER. The FC level measured after six weeks of treatment could predict CR (χ2=9.15, p=0.0025) and ER (χ2=12.31, p=0.0004). The δFC could predict CR (χ2=7.91, p=0.0049), but not ER (χ2=1.85, p=0.1738). With a threshold of ≤950.4 μg/g, FC at week six could predict CR with 76.7% sensitivity and 73.3% specificity. The area under the curve (AUC) was 0.769 (standard error 0.0773, p=0.0005). The same threshold predicted ER with 87.5% sensitivity and 71.4% specificity. The AUC was 0.774 (standard error 0.074, p=0.0002). Conclusion: FC assay at an early stage of treatment can be used as a surrogate marker to predict CR and mucosal healing in pediatric CD.
참고문헌 (24)
- Peyrin-Biroulet L, "Selecting Therapeutic Targets in Inflammatory Bowel Disease(STRIDE) : determining therapeutic goals for treatto-target", Am J Gastroenterol, 110, pp.1324~1338 (2015)
- Zubin G, "Predicting endoscopic Crohn’s disease activity before and after induction therapy in children : a comprehensive assessment of PCDAI, CRP, and fecal calprotectin", Inflamm Bowel Dis, 21, pp.1386~1391 (2015)
- Tibble JA, "Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease", Gastroenterology, 123, pp.450~460 (2002)
- Leach ST, "Fecal markers of inflammation and disease activity in pediatric Crohn disease : results from the ImageKids study", J Pediatr Gastroenterol Nutr, 70, pp.580~585 (2020)
- Schoepfer AM, "Fecal calprotectin correlates more closely with the Simple Endoscopic Score for Crohn’s disease(SES-CD)than CRP, blood leukocytes, and the CDAI", Am J Gastroenterol, 105, pp.162~169 (2010)
- Sipponen T, "Correlation of faecal calprotectin and lactoferrin with an endoscopic score for Crohn’s disease and histological findings", Aliment Pharmacol Ther, 28, pp.1221~1229 (2008)
- Mooiweer E, "Low fecal calprotectin predicts sustained clinical remission in inflammatory bowel disease patients : a plea for deep remission", J Crohn’s Colitis, 9, pp.50~55 (2015)
- Wright EK, "Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn’s disease after surgery", Gastroenterology, 148, pp.938~947 (2015)[DOI]
- Pavlidis P, "Early change in faecal calprotectin predicts primary non-response to anti-TNFα therapy in Crohn’s disease", Scand J Gastroenterol, 51, pp.1447~1452 (2016)
- Guidi L, "Faecal calprotectin assay after induction with anti-Tumour Necrosis Factor α agents in inflammatory bowel disease : prediction of clinical response and mucosal healing at one year", Dig Liver Dis, 46, pp.974~979 (2014)
- Noh SM, "Association of faecal calprotectin level and combined endoscopic and radiological healing in patients with Crohn’s disease receiving anti-tumour necrosis factor therapy", J Crohn’s Colitis, 14, pp.1231~1240 (2020)
- Ferreiro-Iglesias R, "Accuracy of consecutive fecal calprotectin measurements to predict relapse in inflammatory bowel disease patients under maintenance with anti-TNF therapy : a prospective longitudinal cohort study", J Clin Gastroenterol, 52, pp.229~234 (2018)
- Foster AJ, "Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn’s disease patients", World J Gastroenterol, 25, pp.1266~1277 (2019)
- Daperno M, "Development and validation of a new, simplified endoscopic activity score for Crohn’s disease : the SES-CD", Gastrointest Endosc, 60, pp.505~512 (2004)
- Copova I, "Fecal calprotectin is not a clinically useful marker for the prediction of the early nonresponse to exclusive enteral nutrition in pediatric patients with Crohn disease", Eur J Pediatr, 177, pp.685~693 (2018)
- Kostas A, "Fecal calprotectin measurement is a marker of short-term clinical outcome and presence of mucosal healing in patients with inflammatory bowel disease", World J Gastroenterol, 23, pp.7387~7396 (2017)
- Beltrán B, "Fecal calprotectin pretreatment and induction infliximab levels for prediction of primary nonresponse to infliximab therapy in Crohn’s disease", Dig Dis, 37, pp.108~115 (2019)
- D’Arcangelo G, "Predictors of long-term clinical and endoscopic remission in children with Crohn disease treated with infliximab", J Pediatr Gastroenterol Nutr, 68, pp.841~846 (2019)
- Lee Yoo Min, "Association between Fecal Calprotectin and Mucosal Healing in Pediatric Patients with Crohn’s Disease Who Have Achieved Sustained Clinical Remission with Anti-Tumor Necrosis Factor Agents", Gut and Liver, 16(1), pp.62~70 (2022), 거트앤리버 소화기연관학회협의회[DOI]
- Sipponen T, "Faecal calprotectin and lactoferrin are reliable surrogate markers of endoscopic response during Crohn’s disease treatment", Scand J Gastroenterol, 45, pp.325~331 (2010)
- D’Haens G, "Fecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease", Inflamm Bowel Dis, 18, pp.2218~2224 (2012)
- Gisbert JP, "Fecal calprotectin and lactoferrin for the prediction of inflammatory bowel disease relapse", Inflamm Bowel Dis, 15, pp.1190~1198 (2009)
- Kallel L, "Fecal calprotectin is a predictive marker of relapse in Crohn’s disease involving the colon : a prospective study", Eur J Gastroenterol Hepatol, 22, pp.340~345 (2010)
- Jusué V, "Accuracy of fecal calprotectin for the prediction of endoscopic activity in patients with inflammatory bowel disease", Dig Liver Dis, 50, pp.353~359 (2018)