Normalization of Fecal Calprotectin Within 12 Months of Diagnosis Is Associated With Reduced Risk of Disease Progression in Patients With Crohn’s Disease
The level of fecal calprotectin (FC) correlates with endoscopic evidence of inflammation in Crohn’s disease (CD). A treat-to-target algorithm for patients with CD, that incorporates FC, outperforms a treatment strategy based on symptoms alone in the induction of mucosal healing at 12 months. We inve...
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| Veröffentlicht in: | Clinical gastroenterology and hepatology 2021-09, Vol.19 (9), p.1835-1844.e6 |
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| container_title | Clinical gastroenterology and hepatology |
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| creator | Plevris, Nikolas Fulforth, James Lyons, Mathew Siakavellas, Spyros I. Jenkinson, Philip W. Chuah, Cher S. Lucaciu, Laura Pattenden, Rebecca J. Arnott, Ian D. Jones, Gareth-Rhys Lees, Charlie W. |
| description | The level of fecal calprotectin (FC) correlates with endoscopic evidence of inflammation in Crohn’s disease (CD). A treat-to-target algorithm for patients with CD, that incorporates FC, outperforms a treatment strategy based on symptoms alone in the induction of mucosal healing at 12 months. We investigated whether normalization of FC within 12 months of diagnosis of CD is associated with a reduction in disease progression.
We performed a retrospective cohort study at a tertiary IBD centre in the United Kingdom. We identified all incident cases of CD diagnosed from 2005 through 2017. Patients with a FC measurement ≥250 μg/g at diagnosis who also had at least 1 follow-up FC measurement within the first 12 months of diagnosis and >12 months of follow up were included. The last FC measurement within 12 months of diagnosis was used to determine normalization (cut-off |
| doi_str_mv | 10.1016/j.cgh.2020.08.022 |
| format | Article |
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We performed a retrospective cohort study at a tertiary IBD centre in the United Kingdom. We identified all incident cases of CD diagnosed from 2005 through 2017. Patients with a FC measurement ≥250 μg/g at diagnosis who also had at least 1 follow-up FC measurement within the first 12 months of diagnosis and >12 months of follow up were included. The last FC measurement within 12 months of diagnosis was used to determine normalization (cut-off <250 μg/g). The primary endpoint was time to first disease progression (composite of progression in Montreal disease behavior B1 to B2/3, B2 to B3, or new perianal disease; CD-related surgery; or CD-related hospitalization). Cox proportional hazards regression analysis was used to determine independent factors associated with time to first disease progression.
A total of 375 patients out of 1389 incident cases were included, with a median follow up of 5.3 years (interquartile range, 3.1–7.4 years). Normalization of FC within 12 months of diagnosis was confirmed in 43.5% of patients. 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). 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)
Normalization of FC within 12 months of diagnosis is associated with a reduced risk of progression of CD.</description><identifier>ISSN: 1542-3565</identifier><identifier>EISSN: 1542-7714</identifier><identifier>DOI: 10.1016/j.cgh.2020.08.022</identifier><identifier>PMID: 32798706</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Biomarker ; IBD ; Prognosis ; Prognostic Factor</subject><ispartof>Clinical gastroenterology and hepatology, 2021-09, Vol.19 (9), p.1835-1844.e6</ispartof><rights>2021 AGA Institute</rights><rights>Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-6f798bfbdbc4e591db09d8958e9e9cfd15fb0e21406246eef23e819895c9d6173</citedby><cites>FETCH-LOGICAL-c353t-6f798bfbdbc4e591db09d8958e9e9cfd15fb0e21406246eef23e819895c9d6173</cites><orcidid>0000-0002-3229-8759 ; 0000-0002-8062-0685 ; 0000-0003-1884-2401 ; 0000-0003-3352-9253</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.cgh.2020.08.022$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32798706$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Plevris, Nikolas</creatorcontrib><creatorcontrib>Fulforth, James</creatorcontrib><creatorcontrib>Lyons, Mathew</creatorcontrib><creatorcontrib>Siakavellas, Spyros I.</creatorcontrib><creatorcontrib>Jenkinson, Philip W.</creatorcontrib><creatorcontrib>Chuah, Cher S.</creatorcontrib><creatorcontrib>Lucaciu, Laura</creatorcontrib><creatorcontrib>Pattenden, Rebecca J.</creatorcontrib><creatorcontrib>Arnott, Ian D.</creatorcontrib><creatorcontrib>Jones, Gareth-Rhys</creatorcontrib><creatorcontrib>Lees, Charlie W.</creatorcontrib><title>Normalization of Fecal Calprotectin Within 12 Months of Diagnosis Is Associated With Reduced Risk of Disease Progression in Patients With Crohn’s Disease</title><title>Clinical gastroenterology and hepatology</title><addtitle>Clin Gastroenterol Hepatol</addtitle><description>The level of fecal calprotectin (FC) correlates with endoscopic evidence of inflammation in Crohn’s disease (CD). A treat-to-target algorithm for patients with CD, that incorporates FC, outperforms a treatment strategy based on symptoms alone in the induction of mucosal healing at 12 months. We investigated whether normalization of FC within 12 months of diagnosis of CD is associated with a reduction in disease progression.
We performed a retrospective cohort study at a tertiary IBD centre in the United Kingdom. We identified all incident cases of CD diagnosed from 2005 through 2017. Patients with a FC measurement ≥250 μg/g at diagnosis who also had at least 1 follow-up FC measurement within the first 12 months of diagnosis and >12 months of follow up were included. The last FC measurement within 12 months of diagnosis was used to determine normalization (cut-off <250 μg/g). The primary endpoint was time to first disease progression (composite of progression in Montreal disease behavior B1 to B2/3, B2 to B3, or new perianal disease; CD-related surgery; or CD-related hospitalization). Cox proportional hazards regression analysis was used to determine independent factors associated with time to first disease progression.
A total of 375 patients out of 1389 incident cases were included, with a median follow up of 5.3 years (interquartile range, 3.1–7.4 years). Normalization of FC within 12 months of diagnosis was confirmed in 43.5% of patients. 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). 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)
Normalization of FC within 12 months of diagnosis is associated with a reduced risk of progression of CD.</description><subject>Biomarker</subject><subject>IBD</subject><subject>Prognosis</subject><subject>Prognostic Factor</subject><issn>1542-3565</issn><issn>1542-7714</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kcFu1DAURa2qVVsKH9BN5WU3E2wncWJ1VQ0UKpVSVSCWlmO_zHiaiVs_DxKs-A3E3_EleMiUJatnS-fep_suIaecFZxx-XpV2MWyEEywgrUFE2KPHPO6ErOm4dX-7l3Wsj4iLxBXjAlVqeaQHJWiUW3D5DH5dRvi2gz-u0k-jDT09AqsGejcDI8xJLDJj_SLT8s8uKAfwpiWuMXeeLMYA3qk10gvEYP1JoH7y9J7cBubP_ceHyYYwSDQuxgWERC3q7LhXV4KY8JJNI9hOf7-8ROf8ZfkoDcDwqvdPCGfr95-mr-f3Xx8dz2_vJnZsi7TTPY5TNd3rrMV1Iq7jinXqroFBcr2jtd9x0DwiklRSYBelNBylQmrnORNeULOJ9-c-GkDmPTao4VhMCOEDWpRlVVTCyl5RvmE2hgQI_T6Mfq1id80Z3rbiV7p3InedqJZq3MnWXO2s990a3D_FM8lZOBiAiCH_OoharT5LvmAPuYCtAv-P_Z_AGY5nyE</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Plevris, Nikolas</creator><creator>Fulforth, James</creator><creator>Lyons, Mathew</creator><creator>Siakavellas, Spyros I.</creator><creator>Jenkinson, Philip W.</creator><creator>Chuah, Cher S.</creator><creator>Lucaciu, Laura</creator><creator>Pattenden, Rebecca J.</creator><creator>Arnott, Ian D.</creator><creator>Jones, Gareth-Rhys</creator><creator>Lees, Charlie W.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3229-8759</orcidid><orcidid>https://orcid.org/0000-0002-8062-0685</orcidid><orcidid>https://orcid.org/0000-0003-1884-2401</orcidid><orcidid>https://orcid.org/0000-0003-3352-9253</orcidid></search><sort><creationdate>20210901</creationdate><title>Normalization of Fecal Calprotectin Within 12 Months of Diagnosis Is Associated With Reduced Risk of Disease Progression in Patients With Crohn’s Disease</title><author>Plevris, Nikolas ; Fulforth, James ; Lyons, Mathew ; Siakavellas, Spyros I. ; Jenkinson, Philip W. ; Chuah, Cher S. ; Lucaciu, Laura ; Pattenden, Rebecca J. ; Arnott, Ian D. ; Jones, Gareth-Rhys ; Lees, Charlie W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-6f798bfbdbc4e591db09d8958e9e9cfd15fb0e21406246eef23e819895c9d6173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Biomarker</topic><topic>IBD</topic><topic>Prognosis</topic><topic>Prognostic Factor</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Plevris, Nikolas</creatorcontrib><creatorcontrib>Fulforth, James</creatorcontrib><creatorcontrib>Lyons, Mathew</creatorcontrib><creatorcontrib>Siakavellas, Spyros I.</creatorcontrib><creatorcontrib>Jenkinson, Philip W.</creatorcontrib><creatorcontrib>Chuah, Cher S.</creatorcontrib><creatorcontrib>Lucaciu, Laura</creatorcontrib><creatorcontrib>Pattenden, Rebecca J.</creatorcontrib><creatorcontrib>Arnott, Ian D.</creatorcontrib><creatorcontrib>Jones, Gareth-Rhys</creatorcontrib><creatorcontrib>Lees, Charlie W.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Plevris, Nikolas</au><au>Fulforth, James</au><au>Lyons, Mathew</au><au>Siakavellas, Spyros I.</au><au>Jenkinson, Philip W.</au><au>Chuah, Cher S.</au><au>Lucaciu, Laura</au><au>Pattenden, Rebecca J.</au><au>Arnott, Ian D.</au><au>Jones, Gareth-Rhys</au><au>Lees, Charlie W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Normalization of Fecal Calprotectin Within 12 Months of Diagnosis Is Associated With Reduced Risk of Disease Progression in Patients With Crohn’s Disease</atitle><jtitle>Clinical gastroenterology and hepatology</jtitle><addtitle>Clin Gastroenterol Hepatol</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>19</volume><issue>9</issue><spage>1835</spage><epage>1844.e6</epage><pages>1835-1844.e6</pages><issn>1542-3565</issn><eissn>1542-7714</eissn><abstract>The level of fecal calprotectin (FC) correlates with endoscopic evidence of inflammation in Crohn’s disease (CD). A treat-to-target algorithm for patients with CD, that incorporates FC, outperforms a treatment strategy based on symptoms alone in the induction of mucosal healing at 12 months. We investigated whether normalization of FC within 12 months of diagnosis of CD is associated with a reduction in disease progression.
We performed a retrospective cohort study at a tertiary IBD centre in the United Kingdom. We identified all incident cases of CD diagnosed from 2005 through 2017. Patients with a FC measurement ≥250 μg/g at diagnosis who also had at least 1 follow-up FC measurement within the first 12 months of diagnosis and >12 months of follow up were included. The last FC measurement within 12 months of diagnosis was used to determine normalization (cut-off <250 μg/g). The primary endpoint was time to first disease progression (composite of progression in Montreal disease behavior B1 to B2/3, B2 to B3, or new perianal disease; CD-related surgery; or CD-related hospitalization). Cox proportional hazards regression analysis was used to determine independent factors associated with time to first disease progression.
A total of 375 patients out of 1389 incident cases were included, with a median follow up of 5.3 years (interquartile range, 3.1–7.4 years). Normalization of FC within 12 months of diagnosis was confirmed in 43.5% of patients. 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). 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)
Normalization of FC within 12 months of diagnosis is associated with a reduced risk of progression of CD.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32798706</pmid><doi>10.1016/j.cgh.2020.08.022</doi><orcidid>https://orcid.org/0000-0002-3229-8759</orcidid><orcidid>https://orcid.org/0000-0002-8062-0685</orcidid><orcidid>https://orcid.org/0000-0003-1884-2401</orcidid><orcidid>https://orcid.org/0000-0003-3352-9253</orcidid></addata></record> |
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| source | ScienceDirect Journals (5 years ago - present) |
| subjects | Biomarker IBD Prognosis Prognostic Factor |
| title | Normalization of Fecal Calprotectin Within 12 Months of Diagnosis Is Associated With Reduced Risk of Disease Progression in Patients With Crohn’s Disease |
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