Resolution of mucosal inflammation has dramatic effect

In a retrospective cohort study, normalisation of faecal calprotectin (FCP) within 12 months of Crohn’s disease (CD) diagnosis was associated with a reduced risk of disease progression [1]. According to the authors, their findings strongly support implementing treat-to-target strategies earlier than previously tested in CD.

The study was performed in a tertiary inflammatory bowel disease (IBD) centre in the United Kingdom, where all incident cases of CD diagnosed between 2005 and 2017 were identified. Included were patients with an FCP measurement of >250 μg/g at diagnosis who had at least 1 follow-up FCP measured within 12 months of diagnosis and with over 12 months of follow-up. A total of 375 patients were included with a median follow-up of 5.3 years.

Normalisation of FCP (<250 μg/g) within 12 months of diagnosis was confirmed in 163 patients (43.5%). These patients had a significantly lower risk of composite disease progression (HR 0.351; 95% CI 0.235–0.523; P<0.001). At 2, 5, and 7 years after diagnosis, cumulative rates of composite disease progression were 7.8%, 21.4%, and 29.9% in those who normalised their FCP, versus 22.8%, 50.7%, and 60.5% in those that did not. Normalisation of FCP was the only predictor that remained significant for all separate progression endpoints:

• progression in Montreal behaviour/new perianal disease (HR 0.250; 95% CI 0.122–0.512; P<0.001);
• hospitalisation (HR 0.346; 95% CI 0.217–0.553; P<0.001);
• surgery (HR 0.370; 95% CI 0.181–0.755; P=0.006).

According to the authors, the immediate implication for healthcare providers and patients is that by ensuring resolution of mucosal inflammation –measured by proxy with FCP, and regardless of other variables– within 1 year of diagnosis, has a dramatic effect on the course of the disease.

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   1. Plevris N, et al. ECCO-IBD 2020, DOP11.

Posted on 14 April 20208 April 2024