Does fecal calprotectin predict short-term relapse after stopping TNFα-blocking agents in inflammatory bowel disease patients in deep remission?

Molander, Pauliina; Färkkilä, Martti; Ristimäki, Ari; Salminen, Kimmo; Kemppainen, Helena; Blomster, Timo; Koskela, Ritva; Jussila, Airi; Rautiainen, Henna; Nissinen, Markku; Haapamäki, Johanna; Arkkila, Perttu; Nieminen, U; Kuisma, Juha; Punkkinen, Jari; Kolho, Kaija‐Leena; Mustonen, Harri; Sipponen, Taina

doi:10.1016/j.crohns.2014.06.012

Cited by 81 publications

(82 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The median value for FC and CRP before relapse was 534 µg/g and 8 mg/L for those who experienced a relapse and 66.9 µg/g and 3.7 mg/L for those who did not experience a relapse, respectively 65 The optimal cutoffs to predict relapse were 6.1 mg/L for CRP (sensitivity of 71% and specificity of 66%) and 305 µg/g for FC (sensitivity of 70% and specificity of 74%). These results were corroborated by Molander et al 66 A significant proportion of the patients who experienced a relapse were re-treated in 15 studies. With the exception of the study by Sorrentino et al, 35 in which endoscopic remission was reported (100% remission at 80 weeks), most studies only provided rates of clinical remission/ response after re-treatment; in many cases, the information was restricted to the response rates, with no further details.…”

Section: De-escalation Of Anti-tnf In CDsupporting

confidence: 80%

“…An FC level greater than 200 µg/g measured 2 to 4 months before relapse was predictive of relapse (sensitivity of 83% and specificity of 50%); no differentiation was made between CD and UC. 66 Re-treatment rates were reported in 4 trials, 53,54,68,70 with response rates ranging from 67% to 100%. Detailed information was available in only 2 studies.…”

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

“…70 Molander et al, 66 in a follow-up of a previous study, 64 showed that persistently normal FC concentrations during follow-up were highly predictive of clinical and endoscopic remission. An FC level greater than 200 µg/g measured 2 to 4 months before relapse was predictive of relapse (sensitivity of 83% and specificity of 50%); no differentiation was made between CD and UC.…”

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

“…63 Two studies reported on factors predictive of relapse during follow-up rather than at drug discontinuation. 65,66 De Suray et al followed 113 patients in the STORI trial with bimonthly measurements of CRP and FC levels until relapse or 18 months; the investigators found that the evolution of CRP and FC levels was significantly different between those who experienced a relapse and those who did not. In those who experienced a relapse, a sudden and pronounced increase in CRP and FC levels was observed during the 4 months that preceded relapse.…”

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

See 3 more Smart Citations

Systematic Review of Effects of Withdrawal of Immunomodulators or Biologic Agents From Patients With Inflammatory Bowel Disease

et al. 2015

View full text Add to dashboard Cite

Little is known about the optimal duration of therapy with an anti-tumor necrosis factor (TNF) agent and/or an immunomodulator for patients with inflammatory bowel disease (IBD). We performed a systematic search of the literature to identify studies reporting after de-escalation (drug cessation or dose reduction) of anti-TNF agents and/or immunomodulators in patients in remission from IBD. Studies were reviewed according to the type of IBD and drug. Rates of relapse, factors associated with relapse, and response to re-treatment were determined. Our search yielded 6315 unique citations; we analyzed findings from 69 studies (18 on de-escalation [drug cessation or dose reduction] of immunomodulator monotherapy, 8 on immunomodulator de-escalation from combination therapy, and 43 on de-escalation of anti-TNF agents, including 3 during pregnancy) comprising 4672 patients. Stopping immunomodulator monotherapy after a period of remission was associated with high rates of relapse in patients with Crohn's disease or ulcerative colitis (approximately 75% of patients experienced a relapse within 5 years after therapy was stopped). Most studies of patients with Crohn's disease who discontinued an immunomodulator after combination therapy found that rates of relapse did not differ from those of patients who continued taking the drug (55%-60% had disease relapse 24 months after they stopped taking the immunomodulator). The only study in patients with ulcerative colitis supported continued immunomodulator use. Approximately 50% of patients who discontinued anti-TNF agents after combination therapy maintained remission 24 months later, but the proportion in remission decreased with time. Markers of disease activity, poor prognostic factors, and complicated or relapsing disease course were associated with future relapse. In conclusion, based on a systematic review, 50% or more of patients with IBD who cease therapy have a disease relapse. Further studies are required to accurately identify subgroups of patients who are good candidates for discontinuation of treatment. The decision to withdraw a drug should be made for each individual based on patient preference, disease markers, consequences of relapse, safety, and cost.Keywords : Crohn's Disease ; Ulcerative Colitis ; Patient Management ; Cessation.Abbreviations used in this paper : anti-TNF, anti-tumor necrosis factor therapy ; CD, Crohn's disease ; CRP, C-reactive protein ; FC, fecal calprotectin ; IBD, inflammatory bowel disease ; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses ; RCT, randomized controlled trial ; TNF, tumor necrosis factor ; UC, ulcerative colitis.Therapeutic strategies in inflammatory bowel disease (IBD) have evolved considerably in the past few decades. The acknowledgment that subclinical and undertreated inflammation can lead to poor outcomes has underpinned a shift in treatment goals from symptomatic control to sustained clinical and endoscopic remission.1 Treatment strategies have changed accordingly, including the ear...

show abstract

Section: De-escalation Of Anti-tnf In CDsupporting

confidence: 80%

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

Section: De-escalation Of Anti-tnf In CDmentioning

confidence: 99%

See 2 more Smart Citations

Systematic Review of Effects of Withdrawal of Immunomodulators or Biologic Agents From Patients With Inflammatory Bowel Disease

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The study of Molander et al evidenced that calprotectin values below 250 µg/g were observed in clinical remission in 50 patients treated for IBD by anti-TNF antibodies [63]. This threshold is, however, not consensual and may fluctuate depending on the technique used.…”

Section: Therapy Monitoringmentioning

confidence: 99%

Fecal calprotectin in inflammatory bowel diseases: update and perspectives

Manceau

Chicha-Cattoir²,

Puy

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

View full text Add to dashboard Cite

Inflammatory bowel diseases (IBDs) are chronic diseases that result from the inflammation of the intestinal wall, suspected in any patient presenting with intestinal symptoms. Until recently, the diagnosis was mainly based on both clinical and endoscopic arguments. The use of an easy, fast, reliable, non-invasive, and inexpensive biological assay is mandatory not only in diagnosis but also in evolutionary and therapeutic monitoring. To date, the fecal calprotectin is the most documented in this perspective. This marker allows the discrimination between functional and organic bowel processes with good performance. The determination of the fecal calprotectin level contributes to the evaluation of the degree of disease activity and to monitoring of therapeutic response.

show abstract

Withdrawal of immunosuppressant or biologic therapy for patients with quiescent Crohn's disease

Boyapati

Torres

Palmela

et al. 2018

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

The effects of withdrawal of immunosuppressant therapy in people with quiescent Crohn's disease are uncertain. Low quality evidence suggests that continuing azathioprine monotherapy may be superior to withdrawal for avoiding clinical relapse, while very low quality evidence suggests that there may be no difference in clinical relapse rates between discontinuing azathioprine from a combination therapy regimen, compared to continuing combination therapy. It is unclear whether withdrawal of azathioprine, initially administered alone or in combination, impacts on the development of CD-related complications, adverse events, serious adverse events or withdrawal due to adverse events. Further high-quality research is needed in this area, particularly double-blind RCTs in which biologic therapy or an immunosuppressant other than azathioprine is withdrawn.

show abstract

Does fecal calprotectin predict short-term relapse after stopping TNFα-blocking agents in inflammatory bowel disease patients in deep remission?

Abstract: 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.

Cited by 81 publications

References 39 publications

Systematic Review of Effects of Withdrawal of Immunomodulators or Biologic Agents From Patients With Inflammatory Bowel Disease

Systematic Review of Effects of Withdrawal of Immunomodulators or Biologic Agents From Patients With Inflammatory Bowel Disease

Fecal calprotectin in inflammatory bowel diseases: update and perspectives

Withdrawal of immunosuppressant or biologic therapy for patients with quiescent Crohn's disease

Contact Info

Product

Resources

About