Setting up a Virtual Calprotectin Clinic in Inflammatory Bowel Diseases: Literature Review and Nancy Experience

Abstract

Technological progress, including virtual clinics, web or smartphone-based applications, and assessment of fecal calprotectin (FC) at home has favored the implementation of treat to target strategies for patients with inflammatory bowel diseases (IBD). Although these innovations are promising and have been associated with a significant reduction in health costs, their application in clinical practice is limited. Here, we summarize the most recent literature on virtual clinics and available FC home tests. In addition, we report the experience of IBD patients monitored through the IBDoc® test at the Nancy University Hospital, focusing on usability testing and patient’s satisfaction. This pilot experience shows that a virtual calprotectin clinic doubles adherence rate to FC in IBD patients. This finding is especially clinically relevant in the post-coronavirus disease 2019 (COVID-19) pandemic era, with an increasing use of e-health.

Circulating Calprotectin as a Biomarker of COVID-19 Severity

“…Calprotectin is particularly abundant in the cytoplasm of neutrophils and is expressed on the membrane of monocytes and has been recognized as a valid functional biomarker of inflammation as it is involved in recruiting inflammatory cells upon interacting with endothelial cells [5]. Fecal calprotectin represents a reliable biomarker in the context of inflammatory bowel disease [105], which might gain additional value during the COVID-19 pandemic [106,107]. Further, elevated fecal calprotectin has been studied in COVID-19 [107][108][109] where it is associated with intestinal inflammation [110].…”

International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases

“…The home tests allow to measure FC directly at home. It is imperative that patients have a smartphone compatible with the measurement test and that they download an application to perform data analysis 51 . In addition to collecting the feces, patients carry out the extraction process and after placing the feces in the specific reading cassette, they proceed with the sample analysis through the camera of their smartphone.…”

Point-of-Care Testing and Home Testing: Pragmatic Considerations for Widespread Incorporation of Stool Tests, Serum Tests, and Intestinal Ultrasound

“…However, they have shown that patients find them easy to use and prefer them over laboratory tests or endoscopy for monitoring. 31,58,59 However, a previous study found differences in the correlation of the home test with gold standard ELISA according to patient education level. 60 In clinical practice, a subgroup of patients may have difficulties using home tests correctly.…”

“…Point-of-care home testing for FC has shown a potential to improve eHealth monitoring capabilities but has not yet been readily adopted. 30,31 In the near future, point-of-care finger stick dried blood spot CRP, rapid serum drug concentration, and anti-drug antibody tests will add to the capability of eHealth monitoring. However, rapid serum point-of-care tests are not yet accessible in routine clinical practice.…”