Portal de investigação
Tight control using fecal calprotectin and early disease intervention increase the rates of transmural remission in Crohn's disease
Data de publicação:
Data Ahead of Print:
Autores da FMUP
Participantes de fora da FMUP
- Fernandes, SR
- Bernardo, S
- Saraiva, S
- Gonçalves, AR
- Santos, PM
- Valente, A
- Correia, LA
- Cortez-Pinto, H
Unidades de investigação
Abstract
Background: Increasing evidence supports the use of transmural remission as a treatment target in Crohn's disease (CD), but it is seldom achieved in clinical practice. Tight monitoring of inflammation using fecal calprotectin with reactive treatment escalation may potentially improve these results.Aims: To evaluate if treatment escalation based on fecal calprotectin can improve the rates of transmural remission in CD. The influence of the timing of intervention on this strategy was also evaluated.Methods: Retrospective cohort study including 256 CD patients with 2 consecutive assessments by MRI-enterography and colonoscopy and with regular monitoring using fecal calprotectin. For each occurrence of an elevated fecal calprotectin (>= 250 mu g/g), we evaluated whether a reactive adjustment of medical treatment was performed. The ratio of treatment escalation/elevated fecal calprotectin was correlated with the chances of reaching transmural remission. Early disease was defined as disease duration <18 months without previous exposure to immunomodulators and biologics.Results: After a median follow-up of 2 years (IQR 1-4), 61 patients (23.8%) reached transmural remission. Ratios of escalation >= 50% resulted in higher rates of transmural remission (34.2% vs. 15.1%, p < 0.001). The effect was more pronounced in patients with early disease (50.0% vs. 12.0%, p = 0.003). In multivariate analysis, a treatment escalation ratio >= 50% (OR 3.46, 95% CI 1.67-7.17, p = 0.001) and early disease intervention (OR 3.24, 95% CI 1.12-9.34, p = 0.030) were independent predictors of achieving transmural remission.Conclusion: Tight-monitoring and reactive treatment escalation increase the rates of transmural remission in CD. Intervention in early disease further improves these results.
Dados da publicação
- ISSN/ISSNe:
- 2050-6406, 2050-6414
- Tipo:
- Article
- Páginas:
- 451-458
- DOI:
- 10.1002/ueg2.12497
- PubMed:
- 38093503
- Link para outro recurso:
- www.scopus.com
United European Gastroenterology Journal John Wiley & Sons Inc.
Citações Recebidas na Web of Science: 1
Citações Recebidas na Scopus: 3
Documentos
- Não há documentos
Filiações
Keywords
- Crohn's disease; fecal calprotectin; inflammatory bowel disease; transmural remission
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