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

Autor: Fernandes SR; Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal.; Clínica Universitária de Gastrenterologia. Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.; Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal., Bernardo S; Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal.; Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal., Saraiva S; Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal.; Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal., Gonçalves AR; Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal.; Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal., Moura Santos P; Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal.; Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal., Valente A; Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal., Correia LA; Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal.; Clínica Universitária de Gastrenterologia. Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.; Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal., Cortez-Pinto H; Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal.; Clínica Universitária de Gastrenterologia. Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal., Magro F; Portuguese Group of Studies in Inflammatory Bowel Disease, Gedii, Porto, Portugal.; CINTESIS@RISE, Department of Biomedicine, Faculty of Medicine of the University of Porto, Porto, Portugal.
Jazyk: angličtina
Zdroj: United European gastroenterology journal [United European Gastroenterol J] 2024 May; Vol. 12 (4), pp. 451-458. Date of Electronic Publication: 2023 Dec 13.
DOI: 10.1002/ueg2.12497
Abstrakt: 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 μg/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.
(© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)
Databáze: MEDLINE
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