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P627 Surrogate markers of mucosal healing in Crohn's disease patients in clinical remission under biological/immunomodulator treatment

Siakavellas S., Kostas A., Kosmidis C., Gizis M., Papatheodoridis G., Bamias G.

National & Kapodistrian University of Athens, Academic Dpt. of Gastroenterology, Athens, Greece

Background

Mucosal healing is a desired endpoint in both clinical trials and “real-life” practice as it has been associated with better outcomes in patients with IBD. Lower GI endoscopy is required to determine the presence or absence of mucosal healing. Our aim was to assess specific biomarkers that could accurately predict (either alone or in combination) the presence of mucosal healing in Crohn's disease (CD) patients under long-term anti-TNF and/or immunomodulator treatment.

Methods

Eligible patients were those with CD who were on clinical remission for at least 6 months under stable treatment with anti-TNF and/or immunomodulators. Prior to endoscopy all patients were subjected to thorough workup every two months with recordings of Harvey-Bradshaw index score and selected laboratory tests that included fecal calprotectin and serological inflammatory markers. After the end of this 6 month period, colonoscopy was performed and mucosal healing was determined as present [complete (no inflammatory lesions) or partial (minimal inflammatory lesions)] or absent. The predictive value of several clinical and laboratory markers for the presence of mucosal healing was investigated.

Results

Twenty-three patients have been recruited so far (Male=9, Age: 40.8±14.3, 19–70, mean ± SD, range, in years). Fourteen patients (60.8%) achieved mucosal healing as evidenced by lower gastrointestinal endoscopy. Patients in the “no healing” group had significantly higher fecal calprotectin values when compared to patients with mucosal healing at 2 months prior to endoscopy [“no healing” group 554 μg/gr, 235–1800 (median, interquartile range) vs. mucosal healing group 83, 33–330.5, p=0.012), 4 months prior to endoscopy (“no healing”, 600, 338–600 vs. mucosal healing 134, 22.5–272, p=0.009), as well as at 6 months prior to endoscopy respectively (“no healing”, 265.0, 142–482.5 vs. mucosal healing 64, 13.8–199, p=0.039). No significant differences between the two groups were observed regarding CRP levels. Moreover, higher amylase values were found in the “no healing group” in comparison to the healed mucosa group at 6 months prior to endoscopy (91.1 IU/L ± 24.8 vs. 63.1±27.2, mean ± SD, p=0.02). Finally, smokers had less often mucosal healing (p<0.0001) and higher CRP and fecal calprotectin values as well, than non-smokers.

Conclusion

Fecal calprotectin is a better predictor of mucosal healing than CRP in patients with CD in clinical remission. Its use in clinical practice may improve patient management by allowing the identification of patients at higher risk for disease flare, who may require closer follow up and earlier endoscopy.

Funding: The present work has been funded by a grant from the Hellenic Society of Gastroenterology to Dr. Bamias.