Issue 14

Clinical Question

Is there any benefit to monitoring a patient’s response to mesalamine suppository therapy during rectal ulcerative colitis (UC) flares using fecal calprotectin (FCP)?

Editor’s Bottom Line

FCP, used as a regular monitoring biomarker in well patients on maintenance mesalamine will predict a flare approximately 8 weeks before clinical symptoms begin.

Editorial Note

These results are similar to those seen with pan-UC. Monitoring of patients (with inflammatory biomarkers) during maintenance is important as it identifies flares and permits early therapeutic optimization. This author monitors FCP and CRP at least twice yearly in both UC and Crohn’s disease (CD) patients.

Reference

Yamamoto T, Shimoyama T, Matsumoto K. Consecutive monitoring of faecal calprotectin during mesalazine suppository therapy for active rectal inflammation in ulcerative colitis. Aliment Pharmacol Ther. 2015 Sep;42(5):549–58.  https://www.ncbi.nlm.nih.gov/pubmed/26140337

Synopsis

Eligible adults with rectal UC had mild-moderate rectal inflammation (UCDAI=3-9) for less than 4 weeks confirmed by endoscopy. Patients were excluded if they had received any medication for the current flare other than oral mesalamine. During the study, daily mesalamine (1 g) suppositories were used for 8 weeks (induction phase) and were then continued to Week 40 if patients had a clinical response. FC was assessed every 8 weeks. Endoscopies were performed at baseline and at 8 weeks.

After 8 weeks of induction treatment, 118 patients achieved clinical remission with median FC levels decreasing from 18 µg/g at baseline to 11.5 µg/g at Week 8 (P<0.0001). For those who did not attain remission, the FC levels did not decrease (13 µg/g at baseline, 22.5 µg/g at Week 8). During the maintenance phase, increased FC levels (≥55 µg/g) in asymptomatic patients predicted relapse within the following 8 weeks (sensitivity: 88%; specificity: 80%). For the 56 patients who remained in remission until Week 40, their FC levels remained low.

Details

Study Design: Prospective cohort study
Funding: None
Allocation: n/a
Setting: Japan
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.