"The measurement of fecal calprotectin (FC), a surrogate marker of mucosal inflammation, is of interest as a possible means of predicting the course of biological treatment in individual patients. Several publications showed that, in adult patients with Crohn's disease and UC, low FC levels associate with a low degree of inflammation  . In Correspondence: Kaija-Leena Kolho, MD PhD, Children's Hospital, Helsinki University Central Hospital, Box 281, FIN-00029 HUS, Finland. "
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective. Monitoring fecal calprotectin (FC) could assist in the assessment of the therapeutic response of inflammatory bowel disease (IBD). There are few studies on long-term prognosis related to the FC value response to infliximab induction therapy, thus providing the aim of this study on pediatric patients. Methods. FC levels were measured during the induction and maintenance phase of infliximab therapy (5 mg/kg) in 76 pediatric IBD patients introduced to maintenance therapy. The long-term outcomes and clinical disease activity were retrospectively related to the FC response to induction. Results. The median pretreatment FC level of 817 μg/g stool (range <5-24,000) declined to 372 μg/g (range 5-2430) by week 6, with a low level (<100 μg/g) in 35% (pooled comparable data for ulcerative colitis and Crohn's). Clinical activity indices showed remission in 59% (pediatric Crohn's disease activity index: <10, n = 33; pediatric ulcerative colitis activity index: <10 n = 12). In 49 patients (64%), infliximab therapy was discontinued (inadequate effect/surgery = 27; remission/bridging to azathioprine = 12; adverse effect = 6; antibodies to infliximab n = 4) during the study period with a median follow up of 1.1 years (interquartile range [IQR]: 0.71-4.4). Those who discontinued the therapy within the first year due to an inadequate effect had higher median FC level during induction than the other patients (median 633 µg/g, IQR: 197-819 and median 219 µg/g, IQR: 71-508, respectively; p < 0.025) and were less frequently in clinical remission at week 6 (p < 0.01). Conclusions. The long-term prognosis of infliximab therapy is related to the response to induction therapy in pediatric IBD and reflected in low FC values between weeks 2 and 6 and clinical remission.
"Apart from the herein investigated cost-avoidance associated with a reduced need for endoscopies in the diagnostic work-up of IBD, there is also potential for additional economic gains by the use of F-calprotectin testing in treatment follow-up, monitoring of disease activity, and as a prognostic marker for relapse in patients with known IBD who are in remission. These are further examples of situations in which F-calprotectin testing has demonstrated promising results as an alternative investigative method          . "
[Show abstract][Hide abstract] ABSTRACT: To estimate the possible economic effects of a sequential testing strategy with F-calprotectin to minimize colonoscopies.
Retrospective study in a third party payer perspective. The costs were calculated from initial F-calprotectin test results of 3639 patients. Two cut-off levels were used: 50 μg/g feces and 100 μg/g feces, respectively. The cost-effectiveness of the testing strategy was estimated through the short-term cost avoidance and reduction in demand for colonoscopies.
The estimated demand for colonoscopies was reduced by 50% with the 50 μg/g cut-off and 67% with the 100 μg/g cut-off. This corresponded to a cost avoidance of approximately €1.57 million and €2.13 million, respectively.
The use of F-calprotectin as a screening test substantially could reduce the number of invasive measurements necessary in the diagnostic work-up of patients with suspected IBD, as well as the associated costs.
"Roseth et al.  showed a normal faecal calprotectin concentration to be a good predictor of mucosal healing. In that study, some patients had provided calprotectin samples during an earlier active IBD phase and these concentrations were significantly higher than those in remission . In 31 ulcerative colitis (UC) patients followed during a 12-month period, both faecal calprotectin and lactoferrin concentrations were significantly higher in the active than the inactive disease phase . "
[Show abstract][Hide abstract] ABSTRACT: Serial monitoring data for faecal calprotectin and lactoferrin during Crohn's disease (CD) therapy are scarce. The aim of this research was to study the behaviour of faecal biomarkers during CD therapy.
Adult CD patients (n = 19) needing therapy enhancement were prospectively recruited. The simple endoscopic score for Crohn's disease (SES-CD) was administered before and 4-6 months after therapy. At baseline and at 2-3 and 4-6 months, patients provided faecal samples for measurements of calprotectin and lactoferrin.
Of 19 patients, seven were endoscopic responders, three were partial responders and nine were non-responders. During therapy, both faecal-biomarker concentrations decreased significantly in responders: median calprotectin from 1282 microg/g (range 156-2277 microg/g) to 73 microg/g (range 7-2222; P = 0.005) and lactoferrin from 233 microg/g (range 2.8-802 microg/g) to 0.0 microg/g (range 0.0-420 microg/g; P = 0.005), and these changes correlated significantly with changes in the SES-CD. In non-responders, changes in faecal biomarkers were non-significant: calprotectin decreased from 1017 microg/g (range 53-3928 microg/g) to 223 microg/g (range 35-15330 microg/g; P = 0.594) and lactoferrin from 22.5 microg/g (range 2.1-629 microg/g) to 13.0 microg/g (range 3.5-1259 microg/g; P = 0.515).
The faecal neutrophil-derived proteins calprotectin and lactoferrin are reliable surrogate markers of mucosal improvement. Endoscopic responders achieved normalization of faecal biomarkers, whereas in the majority of endoscopic non-responders these markers remained abnormal.
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