Evidence map›Paper›PMID 30726887›Full record

ArticleJournal of Crohn's & colitis2019

Faecal Calprotectin Is a Very Reliable Tool to Predict and Monitor the Risk of Relapse After Therapeutic De-escalation in Patients With Inflammatory Bowel Diseases.

Anthony Buisson, Wing Yan Mak, Michael J Andersen, Donald Lei, Stacy A Kahn, Joel Pekow, Russel D Cohen, Nada Zmeter, Bruno Pereira, David T Rubin

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In one paragraph

Article in Journal of Crohn's & colitis, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Anthony BuissonInflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.
Wing Yan MakInflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.
Michael J AndersenInflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.
Donald LeiInflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.
Stacy A KahnInflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.
Joel PekowInflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.
Russel D CohenInflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.
Nada ZmeterInflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.
Bruno PereiraUniversité Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand, France.
David T RubinInflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.

Funding

ULTRASTRUCTURE AND CYTOMORPHOLOGY COREP30DK042086 · NIDDK · UNIVERSITY OF CHICAGO · PI LIU, CAMBRIAN YANGSHAO · 1990 to 2025
$29.8M
NIDDK NIH HHS P30 DK042086
6 · The paper itself

Abstract

aimsTo assess faecal calprotectin [Fcal] levels before and after therapeutic de-escalation, to predict clinical relapse in patients with inflammatory bowel disease [IBD].

methodsFrom a prospectively maintained database, we enrolled 160 IBD patients [112 Crohn's disease/48 ulcerative colitis] in clinical remission, with Fcal measured within 8 weeks before therapeutic de-escalation. Clinical relapse was defined using the Harvey-Bradshaw index or Simple Clinical Colitis Activity Index.

resultsUsing a receiver operating characteristic [ROC] curve, Fcal >100 µg/g was the best threshold to predict clinical relapse after therapeutic de-escalation (area under the curve [AUC] = 0.84). In multivariate analysis, clinical remission >6 months before therapeutic de-escalation (hazard ratio [HR] = 0.57 [0.33-0.99]; p = 0.044) was associated with decreased risk of relapse, whereas current steroid medication ( = 1.67[1.00-2.79]; p <0.0001) was a risk factor. Fcal >100 µg/g was predictive of clinical relapse (HR = 3.96 [2.47-6.35]; p < 0.0001) in the whole cohort but also in patients receiving anti-tumour necrosis factor [TNF] agents [n = 85 patients; p <0.0001], anti-integrins [n = 32; p = 0.003], or no biologics [n = 43; p = 0.049], or attempting to discontinue steroids [n = 37; p = 0.001]. One patient [1/98] and seven patients [7/88, 8.0%] with baseline Fcal <100 µg/g relapsed within 3 months and 6 months after therapeutic de-escalation, respectively. A total of 74 Fcal measurements were performed in 52 patients after therapeutic de-escalation. Monitoring Fcal >200 µg/g [ROC curve with AUC = 0.96] was highly predictive of clinical relapse in multivariate analysis ([HR = 31.8 [3.5-289.4], p = 0.002). Only two relapses [2/45, 4.4%] occurred within 6 months while Fcal <200 µg/g.

conclusionsFcal level is highly accurate to predict and monitor the risk of relapse after therapeutic de-escalation in IBD patients and could be used in daily practice.

Indexed as

Inflammatory Bowel DiseasesMedication Therapy ManagementAdultBiological ProductsDatabases, FactualFecesFemaleFranceHumansLeukocyte L1 Antigen ComplexMalePredictive Value of TestsReproducibility of ResultsRisk AdjustmentRisk FactorsSecondary PreventionBiological ProductsLeukocyte L1 Antigen ComplexTumor Necrosis Factor Inhibitorsfaecal calprotectinInflammatory bowel diseasetherapeutic de-escalation

Identifiers

PMID30726887
PMCPMC6939876

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.