P718 Faecal calprotectin combined with faecal lactoferrin in predicting the endoscopic outcomes of patients with moderate-to-severe Crohn’s disease receiving infliximab: a pilot study
J. Wu*1, W. Huang2
1Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Gastroenterology, Shanghai, China, 2Janssen, Medical Affairs, Shanghai, China
Endoscopy has been the ‘gold standard’ for the assessment of clinical efficacy in patients with Crohn’s disease (CD), but ileocolonoscopy is still an expensive and invasive method. Noninvasive biomarkers such as faecal calprotectin and lactoferrin can reflect the pathological changes and severity of the intestinal mucosa. Faecal calprotectin has been shown the closer correlation with the Simple Endoscopic Score for Crohn’s Disease (SES-CD) than C-reactive protein (CRP), blood leukocytes, and the Crohn’s Disease Activity Index (CDAI). However, its specificity remains to be improved. The aim of the present study was to evaluate the combination of faecal calprotectin and lactoferrin which improves the accuracy in predicting the endoscopic outcomes (SES-CD) of patients with moderate-to-severe CD receiving infliximab.
Patients with moderate-severe CD, defined as CDAI ≥ 220 and SES-CD > 10, who receiving infliximab were enrolled in a pilot study between November 2014 and October 2015. Serum CRP, faecal calprotectin, and lactoferrin levels were determined quantitatively before treatment and after infliximab-induced remission. Endoscopies were also performed, and the findings were graded according to the SES-CD. SES-CD classification was defined as inactive-mild ≤ 10 and moderate-high > 10. Predicting accuracy was calculated for the combination of faecal calprotectin and lactoferrin, using a multivariable logistic regression model.
Twenty-three patients (male/female = 11/12, with mean age = 37.1 ± 10.6) with moderate-severe CD obtaining infliximab-induced remission were analysed. After infliximab-induced remission, their median concentrations of serum CRP, faecal calprotectin, and lactoferrin reduced significantly (p < 0.001). A faecal calprotectin cut-off value of 237.5 mg/kg achieved the highest summation of sensitivity and specificity for endoscopic remission (79% and 72%, respectively). The combination of faecal calprotectin and faecal lactoferrin measurement produced a higher sensitivity of 90% and a higher specificity of 86% for endoscopic remission.
Table 1 Sensitivity, specificity, and overall accuracy of predicting markers
The combination of noninvasive measurement of faecal calprotectin and lactoferrin seems promising for predicting the endoscopic outcomes of patients with moderate-to-severe CD receiving infliximab, which underlines its usefulness for CD activity monitoring.