title: Consecutive fecal calprotectin measurements to predict relapse in patients with ulcerative colitis receiving infliximab maintenance therapy.
abstract: BACKGROUND
  This study examined whether fecal calprotectin can be used in daily practice as a marker to monitor patients with ulcerative colitis (UC) receiving infliximab maintenance therapy.
  
  
  METHODS
  This prospective multicenter study enrolled adult patients with UC in clinical remission under infliximab maintenance therapy. Fecal calprotectin levels were measured every 4 weeks. Sigmoidoscopies were performed at inclusion and at study end. Relapse was defined as a clinical need for change in treatment or an endoscopic Mayo subscore of ≥2 at week 52. Sustained deep remission was defined as a partial Mayo score <3 at all points and an endoscopic Mayo score 0 at week 52.
  
  
  RESULTS
  Full analysis was possible for 87 of 113 included patients with UC (77%). Of these patients, 30 (34.4%) were considered to be in sustained deep remission and 13 (14.9%) to have relapsed. Calprotectin levels in patients with sustained deep remission remained very low (median < 40 mg/kg at all time points). Patients who flared had significantly higher calprotectin levels (median > 300 mg/kg) already 3 months before the flare. Further receiver operator curve analysis suggested that a calprotectin level >300 mg/kg had a reasonable sensitivity (58.3%) and specificity (93.3%) to model flare. Two consecutive calprotectin measurements of >300 mg/kg with 1-month interval were identified as the best predictor of flare (61.5% sensitivity and 100% specificity).
  
  
  CONCLUSIONS
  Fecal calprotectin can be used in daily practice to monitor patients with UC receiving infliximab maintenance therapy. Two consecutive measurements >300 mg/kg is more specific than a single measurement for predicting relapse.
authors.affiliation: Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium. martine.devos@uzgent.be
authors.forename: Martine
authors.initials: M
authors.lastname: De Vos
authors.forename: Edouard J
authors.initials: EJ
authors.lastname: Louis
authors.forename: Jørgen
authors.initials: J
authors.lastname: Jahnsen
authors.forename: Jo G P
authors.initials: JG
authors.lastname: Vandervoort
authors.forename: Maja
authors.initials: M
authors.lastname: Noman
authors.forename: Olivier
authors.initials: O
authors.lastname: Dewit
authors.forename: Geert R
authors.initials: GR
authors.lastname: Dʼhaens
authors.forename: Denis
authors.initials: D
authors.lastname: Franchimont
authors.forename: Filip J
authors.initials: FJ
authors.lastname: Baert
authors.forename: Roald A
authors.initials: RA
authors.lastname: Torp
authors.forename: Magne
authors.initials: M
authors.lastname: Henriksen
authors.forename: Philippe M R
authors.initials: PM
authors.lastname: Potvin
authors.forename: Philippe P
authors.initials: PP
authors.lastname: Van Hootegem
authors.forename: Pieter M
authors.initials: PM
authors.lastname: Hindryckx
authors.forename: Tom G
authors.initials: TG
authors.lastname: Moreels
authors.forename: Arnaud
authors.initials: A
authors.lastname: Collard
authors.forename: Lars Normann
authors.initials: LN
authors.lastname: Karlsen
authors.forename: Eirik
authors.initials: E
authors.lastname: Kittang
authors.forename: Guy
authors.initials: G
authors.lastname: Lambrecht
authors.forename: Tore
authors.initials: T
authors.lastname: Grimstad
authors.forename: Jonas
authors.initials: J
authors.lastname: Koch
authors.forename: Idar
authors.initials: I
authors.lastname: Lygren
authors.forename: Jean-Claude R J
authors.initials: JC
authors.lastname: Coche
authors.forename: Fazia
authors.initials: F
authors.lastname: Mana
authors.forename: André
authors.initials: A
authors.lastname: Van Gossum
authors.forename: Jacques
authors.initials: J
authors.lastname: Belaiche
authors.forename: Mike R
authors.initials: MR
authors.lastname: Cool
authors.forename: Fernand
authors.initials: F
authors.lastname: Fontaine
authors.forename: Jean-Marc G
authors.initials: JM
authors.lastname: Maisin
authors.forename: Vinciane
authors.initials: V
authors.lastname: Muls
authors.forename: Bart
authors.initials: B
authors.lastname: Neuville
authors.forename: Dirk A J
authors.initials: DA
authors.lastname: Staessen
authors.forename: Gert A
authors.initials: GA
authors.lastname: Van Assche
authors.forename: Thomas
authors.initials: T
authors.lastname: de Lange
authors.forename: Inger Camilla
authors.initials: IC
authors.lastname: Solberg
authors.forename: Bert J K
authors.initials: BJ
authors.lastname: Vander Cruyssen
authors.forename: Severine A R A
authors.initials: SA
authors.lastname: Vermeire
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism*; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012812:Sigmoidoscopy; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D000069285:Infliximab