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Pediatric inflammatory bowel disease: Fecal calprotectin response to Anti-tumor necrosis factor alpha
Manar Matar1, Rachel Levi2, Maya Zvuloni3
1The institute of Gastroenterology, Nutrition and Liver diseases, Schneider Children's Hospital, Petach-Tikva, Israel. manarmatar@gmail.com.
Insights
Anti-tumor necrosis factor alpha (TNFα) therapy effectively reduced fecal calprotectin (FC) levels in most children with inflammatory bowel disease (IBD). Normalization of FC, a key inflammation marker, took about a year, with earlier treatment correlating to faster response.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Clinical Therapeutics
Background:
- Fecal calprotectin (FC) serves as a crucial biomarker for mucosal inflammation in pediatric inflammatory bowel disease (IBD).
- Assessing the impact of anti-tumor necrosis factor alpha (anti-TNFα) therapy on FC levels is vital for treatment monitoring in IBD.
Purpose of the Study:
- To evaluate the efficacy of anti-TNFα therapy in reducing FC levels in pediatric IBD patients.
- To determine the time course for achieving FC response and normalization during anti-TNFα treatment.
Main Methods:
- Retrospective analysis of medical records of pediatric IBD patients treated with anti-TNFα agents between 2015-2020.
- Measurement of FC levels before and sequentially after anti-TNFα induction therapy.
- Assessment of time to achieve predefined FC response cutoffs (250, 150, 100, and 50 µgr/gr).
Main Results:
- A significant majority of patients (82%) achieved an FC level below 250 µgr/gr within the study period.
- Median times to reach FC cutoffs varied, with normalization (<50 µgr/gr) taking a median of 18.5 months.
- Earlier initiation of anti-TNFα therapy after diagnosis was significantly associated with achieving lower FC levels (<50 µgr/gr).
Conclusions:
- Anti-TNFα therapy leads to prompt FC response in most pediatric IBD patients.
- Complete FC normalization typically requires approximately one year of sustained therapy.
- Physicians should consider the extended timeline for FC normalization when managing pediatric IBD patients on anti-TNFα therapy.
Background:
Fecal calprotectin (FC) is a marker of mucosal inflammation in inflammatory bowel disease (IBD). We aimed to assess the effect of anti-tumor necrosis factor alpha (TNFα) therapy on FC levels in children with IBD.
Methods:
The medical records of pediatric patients treated with anti-TNFα agents (2015-2020) were reviewed retrospectively. 63 patients had FC levels measured prior to anti TNFα induction with sequential measurements during follow-up. The main outcome measures were time to FC response according to cutoffs of 250, 150, 100 and 50 µgr/gr.
Results:
Mean age was 13.6 ± 3 years [females 28 (44.4%), Crohn's 55 (87%)]. Outcomes of < 250, < 150, < 100 and < 50 µgr/gr were achieved by 52 (82%), 51 (81%), 44 (70%) and 32 (50%), respectively. The median time for achieving these cutoffs was 4.8 (1.8-15.6), 7.9 (2.6-16.4), 10.0 (3.5-20.5) and 18.5 (7.0-64.7) months, respectively. Shorter time from diagnosis to treatment was associated with achievement of FC < 50 µgr/gr (p = 0.03). There was no association between age, disease type, anti-TNFα type, inflammatory markers, disease activity indices at baseline and induction anti-TNFα trough concentration and FC response.
Conclusions:
FC response was achieved by the majority of patients treated with anti-TNFα within a short period of time. FC normalization in responders required almost one year.
Impact:
Fecal calprotectin response was achieved by the majority of pediatric patients within a relatively short period of time after anti-TNFα induction and maintenance therapy. Fecal calprotectin normalization required an average period of approximately one year in responders. The faster response of fecal calprotectin is associated with shorter time from diagnosis to anti-TNFα treatment. Inflammatory bowel disease treating physicians should be aware of the relatively prolonged time to fecal calprotectin normalization and to allow enough time for anti-TNFα therapy to express its full potential prior to significant interventions.
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