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  3. Tight control using fecal calprotectin and early disease intervention increase the rates of transmural remission in Crohn's disease

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

  • Fernando José Magro Dias

    Autor

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

United European Gastroenterology Journal  John Wiley &amp; Sons Inc.

Tipo:
Article
Páginas:
451-458
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 1

Citações Recebidas na Scopus: 3

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Keywords

  • Crohn's disease; fecal calprotectin; inflammatory bowel disease; transmural remission

Campos de estudo

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