Normalizing the level of fecal calprotectin (FC) in patients with Crohn disease (CD) within 12 months of diagnosis reduces the risk of disease progression, according to a retrospective study.
The study was based on the correlation of the level of FC with endoscopic evidence of inflammation and healing of mucosa in patients with CD. The researchers also noted, “A treat-to-target algorithm for patients with CD, that incorporates FC, outperforms a treatment strategy based on symptoms alone in induction of mucosal healing at 12 months.”
The researchers included 375 patients at a tertiary center for inflammatory bowel disease who were diagnosed with CD between January 1, 2005, and December 31, 2017. These patients also had FC measurements of more than 250 μg/g when diagnosed and received at least one follow-up FC measurement within 12 months following diagnosis.
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The study team used the final measurement within the 12 months post-diagnosis to determine normalization of FC, with a cut-off measurement of more than 250 μg/g.
The primary endpoint for this study was time to first progression of disease, defined as surgery related to CD; hospitalization for CD; or composite progression in Montreal disease behavior B1 to B2 or 3, B2 to B3, or new perianal disease.
“Patients with normalized levels of FC had a significantly lower risk of composite disease progression (hazard ratio [HR], 0.36; 95% CI, 0.24–0.53; P<.001),” the researchers concluded. “They also had a lower risk of reaching any of the separate progression endpoints (progression in Montreal behavior or new perianal disease HR, 0.22; 95% CI, 0.11–0.45; P<.001; hospitalization HR, 0.33; 95% CI, 0.21–0.53; P<.001; surgery HR, 0.39; 95% CI, 0.19–0.78; P=.008).”
Plevris N, Fulforth J, Lyons M, et al. Normalization of fecal calprotectin within 12 months of diagnosis is associated with reduced risk of disease progression in patients with Crohn’s disease. Clin Gastroenterol Hepatol. Published online August 12, 2020. https://doi.org/10.1016/j.cgh.2020.08.022