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Early Change in Fecal Calprotectin Predicts One-Year Outcome in Children Newly Diagnosed With Ulcerative Colitis
Chenthan Krishnakumar1, Ashwin N Ananthakrishnan2, Brendan M Boyle3
1Division of Pediatric Gastroenterology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA.
Insights
Serial fecal calprotectin (FC) levels, not baseline values, predict clinical outcomes in pediatric ulcerative colitis (UC). Early reduction in FC by 12 weeks significantly increases the likelihood of remission.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Biomarker Discovery
Background:
- Fecal calprotectin (FC) is a marker for disease activity in ulcerative colitis (UC).
- Limited data exist on the predictive value of serial FC levels at diagnosis for long-term outcomes in pediatric UC.
- Understanding early predictors can optimize treatment strategies.
Purpose of the Study:
- To investigate if FC levels at diagnosis or early changes in FC predict clinical outcomes in children with newly diagnosed UC.
- To compare the prognostic value of baseline FC versus changes in FC at 4 and 12 weeks.
- To identify early indicators of treatment response and disease course.
Main Methods:
- A cohort of 352 children with newly diagnosed UC was analyzed.
- Patients received standardized treatment with mesalamine or corticosteroids (CS).
- FC levels were measured at baseline, week 4, and week 12. Clinical outcomes, including CS-free remission at week 52, were assessed.
Main Results:
- Baseline FC levels did not predict CS-free remission at week 52.
- FC levels at week 4 and week 12 were associated with outcomes, with week 12 showing a stronger correlation.
- A decrease of >75% in FC by week 12 was associated with a threefold increased likelihood of achieving CS-free remission at one year.
Conclusions:
- Longitudinal changes in FC levels are more predictive of one-year outcomes than baseline FC in pediatric UC.
- Early reduction in FC by 12 weeks is a significant predictor of successful treatment and remission.
- Serial FC monitoring can aid in tailoring therapy and predicting the clinical course in pediatric UC.
Introduction:
While fecal calprotectin (FC) is used to assess disease activity in ulcerative colitis (UC) there are little data concerning the role of serial FC levels at diagnosis in predicting clinical course. We sought to determine whether FC at diagnosis or early change following therapy predicts clinical outcomes in pediatric UC.Methods: Children with newly diagnosed UC were treated with standardized regimens of mesalamine or corticosteroids (CS). CS tapering and escalation to additional therapy or colectomy were by protocol. Patients with baseline or week 4 or week 12 FC levels were included in the analysis. Our primary outcome was CS-free remission on mesalamine at week 52. We compared the prognostic value of a baseline FC as well as a change in FC by week 4 or week 12 in predicting clinical outcomes.
Results:
The study included 352 children (113 initial mesalamine, 239 initial CS, mean age 12.6 years) with UC. At Week 52, 135 (38.3%), 84 (23.8%), and 19 (5.4%) children achieved CS-free remission, needed anti-tumor necrosis factor therapy or had colectomy respectively. Baseline FC was not associated with CS-free remission at week 52. However, both week 4 (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.901.00) and week 12 FC levels (OR 0.91, 95% CI 0.87-0.96) were associated with outcomes, with the latter having a stronger association with CS-free remission. Patients with a >75% decrease by 12 weeks, had a 3-fold increased likelihood of CS-free remission at 1 year.
Discussion:
Longitudinal changes in FC may predict 1 year outcomes better than values at diagnosis in children with a new diagnosis of UC.
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