In patients with ulcerative colitis (UC) treated with infliximab (IFX), can fecal biomarkers (calprotectin, lactoferrin) and C-reactive protein (CRP) predict histological mucosal healing?
Fecal calprotectin (Fcal), but not CRP accurately predicts histological healing in patients with UC. This confirms that Fcal can be used as a surrogate to colonoscopy in the assessment of mucosal healing in UC patients.
Magro F, Lopes SI, Lopes J, et al; Portuguese IBD group [GEDII]. Histological Outcomes and Predictive Value of Faecal Markers in Moderately to Severely Active Ulcerative Colitis Patients Receiving Infliximab. J Crohns Colitis. 2016 Dec;10(12):1407–16. https://www.ncbi.nlm.nih.gov/pubmed/27226417
Patients on maintenance IFX (5 mg/kg) with moderate-severe UC were prospectively enrolled. All were previously biologically naïve. The primary study end point was the correlation between histological remission with Fcal, CRP, or lactoferrin at weeks 8 and 52. Remission levels were defined as <100 µg/g for Fcal, ≤7.25 µg/g for lactoferrin, and ≤3.0 mg/l for CRP.
At baseline, 5% of the 20 patients were in histological remission (Geboes index ≤3.0); at weeks 8 and 52, this increased to 15% and 35%, respectively. At week 8, both Fcal and lactoferrin had good correlation with histology results with the area under the curve (AUC) being 94% (P=0.017) for Fcal and 96% (P=0.013) for lactoferrin; the positive predictive values (PPV) were 100% (P=0.017) and 94% (P=0.013), respectively. At 8 weeks, the correlation between histology and CRP was non-significant. At week 52, the sensitivity and specificity for detecting histological remission was only 69% and 57% (P=0.029) for Fcal, and 85% and 71% (P=0.024) for lactoferrin.
Study Design: Multicentre cohort study
Funding: Merck Sharp & Dohme, Portugal
Level of Evidence: 2b (Oxford Levels of Evidence)
The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.