Comparison of fecal calprotectin and serum C-reactive protein in early prediction of outcome to infliximab induction therapy

Abstract

Background: Fecal calprotectin (FC) and serum C-reactive protein (CRP) are biomarkers of disease activity in Crohn's disease (CD) and ulcerative colitis (UC). We assessed FC, CRP, Harvey-Bradshaw index (HBi), partial Mayo Clinic Scoring (pMCS) and a cytokine panel during infliximab induction to predict therapy outcome. Methods: FC, CRP and clinical indices were evaluated in 123 (76 CD, 47 UC) patients before infliximab induction and after 12 weeks. Responders were monitored 48 weeks for an 'incident' (dosage increase, shortened dosage interval, surgery). Cutoff values for FC and CRP were obtained using receiver-operating characteristics (ROC). Disease progression was analyzed with Kaplan-Meier survivals, log-rank test and logistic regression for combined biomarkers. Cytokines were analyzed with Luminex multiplexing system. Results: Following infliximab, FC and CRP declined (p < .0001) along with HBi for CD and pMCS for UC. Simultaneously, IL-6 and TNF-a decreased, while IL-10 increased. Optimal FC ROC cutoff was 221 mg/g (sensitivity 66%, specificity 67%, AUC 0.71) and CRP ROC cutoff 2.1 mg/L (sensitivity 54%, specificity 60%, AUC 0.58). In CD, FC > 221 mg/g (p < .0001), but not CRP > 2.1 mg/L predicted an 'incident'. However, combined FC and CRP also predicted an 'incident' (p < .042). In UC, both FC > 221 mg/g (p < .0005) and CRP > 2.1 mg/L (p ¼ .0334) predicted 'incident', as did combined biomarkers (p < .005). Conclusions: Clinical disease activity is reduced by treatment with infliximab. In CD, persistently high FC, but not CRP, predict a treatment 'incident', whereas in UC both high FC and high CRP predict 'incident'. Combined FC and CRP values also predict an 'incident'.

Influence of Vitamin D3 Supplementation on Infliximab Effectiveness in Chinese Patients With Crohn's Disease: A Retrospective Cohort Study

“…Summarizing these findings, we speculated that IL-6 and TNF-α may be the potential targets related to the therapeutic effects of IFX in CD, though the mechanism was not fully understood. Consistent with our study, Engstrom et al noticed that IL-6 and TNF-α levels were lower in IBD patients after 12 weeks IFX administration (39). Kato et al noted that IL-6 and TNF-α levels were reduced in CD patients after the initial IFX infusion (2 weeks), but not in 14 weeks (40).…”

Measurement of pre‐treatment inflammatory cytokine levels is valuable for prediction of treatment efficacy to tumor necrosis factor inhibitor in axial spondyloarthritis patients

“…(a) IL‐17A plays a vital role in the development of inflammation in axSpA patients; meanwhile, a high baseline IL‐17A level indicates a more serious inflammatory condition, which intensifies the efficacy of the TNF inhibitors, thereby causing a higher ASAS40 response rate 20,25 . (b) CRP is a well‐known acute phase inflammatory marker, extensive studies disclose that its high baseline expression is related to an excellent response to TNF inhibitors in autoimmune diseases including RA and Crohn disease and axSpA 21,26,27 . In axSpA patients, we suppose that a high baseline CRP level is correlated with aggravating disease status, including high disease activity and exacerbating inflammatory conditions; in addition, patients with disturbing disease status may benefit more from the TNF inhibitor treatment, thereby, leading to a higher ASAS40 response rate.…”

“…20,25 (b) CRP is a well-known acute phase inflammatory marker, extensive studies disclose that its high baseline expression is related to an excellent response to TNF inhibitors in autoimmune diseases including RA and Crohn disease and axSpA. 21,26,27 In axSpA patients, we suppose that a high baseline CRP level is correlated with aggravating disease status, including high disease activity and exacerbating inflammatory conditions; in addition, patients with disturbing disease status may benefit more from the TNF inhibitor treatment, thereby, leading to a higher ASAS40 response rate. (c) Patients with axSpA with a history of TNF inhibitor use may have a higher level of anti-drug antibody compared with the TNF inhibitor naive patients, which would decrease the blood concentration of adalimumab, thereby causing a worse efficacy in these patients.…”

Association of Serum Neuron-Specific Enolase and C-Reactive Protein With Disease Location and Endoscopic Inflammation Degree in Patients With Crohn's Disease

“…Multiple biomarkers such as serum calprotectin, albumin, and C-reactive protein (CRP) have been studied to estimate the disease severity in CD ( 7 ). Many studies have recently shown that fecal calprotectin (FC) can be used as a non-invasive biomarker of disease activity ( 8 – 10 ). However, FC might not be increased in patients with CD who predominantly have ileal involvement ( 11 ).…”