Pauliina Molander1, Martti Färkkilä2, Ari Ristimäki3, Kimmo Salminen4, Helena Kemppainen4, Timo Blomster5, Ritva Koskela5, Airi Jussila6, Henna Rautiainen7, Markku Nissinen8, Johanna Haapamäki9, Perttu Arkkila9, Urpo Nieminen9, Juha Kuisma10, Jari Punkkinen11, Kaija-Leena Kolho12, Harri Mustonen13, Taina Sipponen9. 1. Maria Helsinki City Hospital and University of Helsinki, Helsinki, Finland pauliina.molander@welho.com. 2. Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland University of Helsinki, Institute of Clinical Medicine, Department of Medicine, Division of Gastroenterology, Helsinki, Finland. 3. Department of Pathology, HUSLAB and Haartman Institute, Helsinki University Central Hospital and Genome-Scale Biology, Research Programs Unit, University of Helsinki, Helsinki, Finland. 4. Department of Medicine, Division of Gastroenterology, Turku University Central Hospital, Turku, Finland. 5. Department of Medicine, Division of Gastroenterology, Oulu University Central Hospital, Oulu, Finland. 6. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. 7. Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland. 8. Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Peijas Hospital, Vantaa, Finland. 9. Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland. 10. Department of Medicine, Hyvinkää Hospital, Hyvinkää, Finland. 11. Department of Medicine, Porvoo Hospital, Porvoo, Finland. 12. Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland University of Helsinki, Institute of Clinical Medicine, Department of Medicine, Division of Gastroenterology, Helsinki, Finland. 13. Helsinki University Central Hospital, Department of Surgery, Biomedicum Helsinki, Finland.
Abstract
BACKGROUND AND AIMS: This prospective multicenter study examined whether elevated fecal calprotec tin (FC) concentrations after stopping TNFα-blocking therapy can predict clinical or endoscopic relapse. In addition, we evaluated the impact of histological remission on the relapse risk. METHODS: We enrolled inflammatory bowel disease (IBD) patients who were in clinical, endoscopic, and FC-based (< 100 μg/g) remission after a minimum 11 months of TNFα-blocking therapy. The patients were followed-up for 12 months after the discontinuation of TNFα-blocking therapy. FC was collected monthly for the first 6 months and thereafter every second month. Ileocolonoscopy was performed at inclusion, at 4 months, at the study end, and at the time of clinical relapse. RESULTS: Of 52 enrolled patients, 49 (16 Crohn's disease, 33 ulcerative colitis/IBD unclassified) provided the stool samples requested and comprised the study group. During the follow-up, 15/49 (31%) relapsed, whereas 34 (69%) remained in remission. Patients relapsing showed constantly elevated FC levels for a median of 94 (13-317) days before the relapse. Significant increase in median FC levels was seen 2 (p = 0.0014), 4 (p = 0.0056), and 6 (p = 0.0029) months before endoscopic relapse. Constantly normal FC concentrations during the follow-up were highly predictive for clinical and endoscopic remission. Normal FC concentrations in patients with remission were associated with histological remission. CONCLUSION:FC seems to increase and remain elevated before clinical or endoscopic relapse, suggesting that it can be used as a surrogate marker for predicting and identifying patients requiring close follow-up in clinical practice.
RCT Entities:
BACKGROUND AND AIMS: This prospective multicenter study examined whether elevated fecal calprotec tin (FC) concentrations after stopping TNFα-blocking therapy can predict clinical or endoscopic relapse. In addition, we evaluated the impact of histological remission on the relapse risk. METHODS: We enrolled inflammatory bowel disease (IBD) patients who were in clinical, endoscopic, and FC-based (< 100 μg/g) remission after a minimum 11 months of TNFα-blocking therapy. The patients were followed-up for 12 months after the discontinuation of TNFα-blocking therapy. FC was collected monthly for the first 6 months and thereafter every second month. Ileocolonoscopy was performed at inclusion, at 4 months, at the study end, and at the time of clinical relapse. RESULTS: Of 52 enrolled patients, 49 (16 Crohn's disease, 33 ulcerative colitis/IBD unclassified) provided the stool samples requested and comprised the study group. During the follow-up, 15/49 (31%) relapsed, whereas 34 (69%) remained in remission. Patients relapsing showed constantly elevated FC levels for a median of 94 (13-317) days before the relapse. Significant increase in median FC levels was seen 2 (p = 0.0014), 4 (p = 0.0056), and 6 (p = 0.0029) months before endoscopic relapse. Constantly normal FC concentrations during the follow-up were highly predictive for clinical and endoscopic remission. Normal FC concentrations in patients with remission were associated with histological remission. CONCLUSION:FC seems to increase and remain elevated before clinical or endoscopic relapse, suggesting that it can be used as a surrogate marker for predicting and identifying patients requiring close follow-up in clinical practice.
Authors: Christopher Andrew Lamb; Nicholas A Kennedy; Tim Raine; Philip Anthony Hendy; Philip J Smith; Jimmy K Limdi; Bu'Hussain Hayee; Miranda C E Lomer; Gareth C Parkes; Christian Selinger; Kevin J Barrett; R Justin Davies; Cathy Bennett; Stuart Gittens; Malcolm G Dunlop; Omar Faiz; Aileen Fraser; Vikki Garrick; Paul D Johnston; Miles Parkes; Jeremy Sanderson; Helen Terry; Daniel R Gaya; Tariq H Iqbal; Stuart A Taylor; Melissa Smith; Matthew Brookes; Richard Hansen; A Barney Hawthorne Journal: Gut Date: 2019-09-27 Impact factor: 23.059
Authors: Talia Zenlea; Eric U Yee; Laura Rosenberg; Marie Boyle; Kavinderjit S Nanda; Jacqueline L Wolf; Kenneth R Falchuk; Adam S Cheifetz; Jeffrey D Goldsmith; Alan C Moss Journal: Am J Gastroenterol Date: 2016-03-15 Impact factor: 10.864