Early fecal calprotectin change predicts outcomes in pediatric UC - Healio

SAN DIEGO — Pediatric patients with ulcerative colitis who displayed a rapid drop-off of fecal calprotectin levels in the first 12 weeks of treatment experienced better 1-year outcomes, according to research presented at Digestive Disease Week.

Chenthan Krishnakumar, MD, of the division of pediatric gastroenterology at Emory University, said physicians regularly use fecal calprotectin to monitor inflammation in patients with UC, but little research has focused on how early levels relate to week 52 outcomes.

“Our aims are to determine if baseline fecal calprotectin at diagnosis predicts week 52 clinical outcome in UC in children,” he said in his presentation. “And to determine if early changes in fecal calprotectin — week 4 and/or week 12 compared with baseline — following initial therapy predict week 52 clinical outcome in UC in children.”

Researchers analyzed data from the PROTECT study, which comprised 248 children with newly diagnosed moderate-to-severe UC (mean age 13 years, 51% boys). Patients received standardized regimens of corticosteroids tapered by protocol. Patients who failed to respond to the steroids received additional immunomodulators or anti-TNF.

The study’s primary outcome was corticosteroid-free remission – defined as a Pediatric UC Activity Index score less than 10 – on mesalamine only without additional medical therapy or colectomy at week 52. By week 52, 77 children were in steroid-free remission (32%), 84 needed anti-TNF (34%) and 19 had a colectomy (8%).

Krishnakumar and colleagues found that baseline fecal calprotectin level was not a good predictor of week 52 outcomes, as it was not associated with corticosteroid-free remission, need for anti-TNF therapy or colectomy. Fecal calprotectin level at week 12 was associated with corticosteroid-free remission (OR = 0.88; 95% CI, 0.82–0.94).

Compared with patients who experienced an increase or a less than 25% decrease in fecal calprotectin, those who experienced more than a 75% decrease by week 12 had a much greater likelihood of achieving corticosteroid-free remission (OR= 4.69; 95% CI, 1.27–17.24). A fecal calprotectin reduction greater than 75% was also associated with a decreased need for anti-TNF therapy (OR = 0.26; 95% CI, 0.07–1.06). – by Alex Young

Reference:

Krishnakumar C, et al. Abstract 302. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Krishnakumar reports no relevant financial disclosures. Please see the meeting disclosure index for all other authors’ relevant financial disclosures.

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