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* = Presenting author

P472 Faecal calprotectin as a biomarker of early mucosal healing in patients with ulcerative colitis naïve to adalimumab treatment

C. Muñoz Villafranca*1, A. Perez de Arenaza2, L. Gómez3, R. Higuera4, A. Munagorri5, M. A. Ogueta6, S. Ibañez7, J. Ortiz de Zárate8, O. Merino3, C. Rodriguez9, O. Nante9, P. Arreba10, P. Ramirez de la Piscina11, I. Rodríguez12, A. Bernal13, J. A. Arévalo13, J. L. Cabriada13

1Hospital Universitario de Basurto, Aparato Digestivo, Bilbao, Spain, 2Hospital Universitario de Basurto, Bilbao, Spain, 3Hospital Universitario de Cruces, Gastroenterology, Baracaldo, Spain, 4Hospital San Eloy, Gastroenterology, Baracaldo, Spain, 5Hospital Donostia, Gastroenterology, Donosti, Spain, 6Hospital de Santiago, Gastroenterology, Vitoria, Spain, 7Hospital Universitario de Cruces, Gastroenterology, Baracaldo, Spain, 8Hospital Universitario de Basurto, Gastroenterology, Bilbao, Spain, 9Hospital de Navarra, Gastroenterology, Pamplona, Spain, 10Hospital Universitario de Basurto, Gastroenterology, Bilbao, Spain, 11Hospital de Txagorritxu, Gastroenterology, Vitoria, Spain, 12Hospital de Galdakao, Galdakao, Spain, 13Hospital de Galdácano, Gastroenterology, Galdácano, Spain

Background

Faecal calprotectin (FC) levels correlate with inflammation in inflammatory bowel disease. Further, mucosal healing (MH) is one the most important targets in the treatment of ulcerative colitis (UC). We studied the ability of FC to predict early MH in patients with UC after treatment with adalimumab (ADA).

Methods

We conducted a multicentre, prospective, and observational study in anti-TNF naïve patients with UC who were treated with ADA. FC levels (in µg/g) were determined at weeks 0 (the beginning of treatment), 4 and 8. The mucosa was evaluated at weeks 0 and 8, with Mayo sub-score of (0–3) and clinical activity was evaluated with Mayo sub-score (0–9) at weeks 0, 4, and 8. Mayo score (0–12) was calculated at weeks 0 and 8. We considered MH, sub-score 0 and 1. Clinical remission was defined by a Mayo score < 2 or a sub-score of 0. Clinical response, as a drop of 3 points in the score. We performed a descriptive analysis with SPSS. Continuous variables were described with means and standard deviations if they followed a normal distribution and with medians and interquartile ranks (IQR) otherwise. Frequencies and percentages were employed for discrete variables

Results

Included were 40 patients (23 men [57.5%]). Mean age was 44.6 ± 12.6. Further, 18, (45%) were steroid-resistant and 22 (55%) steroid-dependent. At baseline, 19 patients had a Mayo endoscopic sub-score of 3 (severe), 20 of 2 (moderate), and 1 had 1 (mild). Median (IQR) Mayo score and FC level were 10 (9–10) and 1 000 µg/g (525–1 196), respectively. At week 8, 23 patients (57.5%) developed MH, 10 had a score of 0 and 13 a score of 1. Clinical response was achieved in 31 patients (77.5%). FC levels at week 8 decreased to 313 µg/g (IQR 205–750) in patients with no MH and to 143 µg/g (IQR 50–469) in patients with MH (p = 0.018). In the logistic regression, only FC showed statistically significant association with MH at week 8. Area under ROC curve was 0.75 (CI 95% 0.59–0.91). A cut-off value of 260 µg/g on FC provided the best trade-off between sensitivity (0.74) and specificity (0.64). When MH was considered only if Mayo sub-score = 0, the area under ROC curve was 0.77 (CI 95% 0.62–0.93). A good combination of sensitivity (0.8) and specificity (0.67) was obtained for a cut-off value of 200 µg/g

Conclusion

1. FC is a good biomarker to predict early MH in patients with UC naïve to ADA treatment. 2. In patients with MH, there could be differences between sub-groups MH (= 0), and MH (= 1).