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P109. Use of faecal calprotectin as predictor of relapse in patients under maintenance treatment with infliximab

R. Ferreiro1, M. Barreiro-de Acosta1, M. Otero2, A. Lorenzo1, C. Alonso2, J.E. Dominguez-Munoz1, 1University Hospital, Gastroenterology, Santiago, Spain, 2Department of Laboratory Medicine, Santiago, Spain

Background

In inflammatory bowel disease (IBD), predicting relapse by measuring non-invasive biomarkers could allow early changes to treatment. Data is scarce regarding the usefulness of close monitoring with calprotectin to predict relapse. The aim of the study was to evaluate the predictive value of a faecal calprotectine test checking for flares in patients with IBD under maintenance treatment with Infliximab.

Methods

A prospective study was designed. Inclusion criteria were IBD patients (Crohn's disease [CD] and ulcerative colitis [UC]) in clinical remission under a continuous 5 mg/kg Infliximab therapy. Fresh faecal calprotectin was measured using a rapid test on the day of the drug infusion. Clinical examination was performed two months after infusion. Relapse was defined as a Harvey–Bradshaw score >4 in CD patients and as a Mayo score >2 in UC patients. The U-Mann–Whitney test and the ROC analysis were performed in SPSS.

Results

53 patients were included; mean age 46±2 years; 28 (52.8%) being female, 62.3% having CD and 37.7% UC. After two months, 41 (77.4%) patients remained in clinical remission and 12 (22.6%) presented a relapse.

For patients in remission mean calprotectin levels were 110 mg/kg of faeces. Patients who flared had significantly higher calprotectin levels than patients in remission (p < 0.005). The calprotectin levels in patients with relapse had a mean of 332 mg/kg.

A further ROC analysis (flare vs remission) suggested that a calprotectin level of 110.5 mg/kg was the best cut-off point showing high sensitivity (100%) and high specificity (73.2%) to confirm the flare. The area under the curve was 0.88 with good accuracy (p < 0.005).

Conclusion

In IBD patients under infliximab maintenance therapy, calprotectin levels highly correlate with a predictor of relapse. Remission is associated with low calprotectine levels. More studies and an increased number of patients should confirm the usefulness of calprotectin to modulate therapy during medical checks.