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Poster 406 Fecal Calprotectin Levels Predict Histological Healing in Ulcerative Colitis
Author Insight from Anish Patel, DO, Carl R. Darnall Army Medical Center
What’s new here and important for clinicians?
With new advances in the medical management of Ulcerative Colitis (UC), treatment targets have been modified to target remission. Targets based on using symptoms do not necessarily alter the course of disease, resulting in looking beyond symptoms such as healing seen on endoscopy. However, the feasibility of performing recurrent endoscopies and/or imaging is limited by significant costs, availability and invasive nature of these procedures. As a result, surrogate biomarkers of inflammation, such as fecal calprotectin (FC), are being increasingly studied.
Results from the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) program, initiated by the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD), experts determined one of the main “treat-to-target” goals for UC included endoscopic remission (defined as resolution of visible mucosal inflammation and ulceration). However, histological healing is a distinct endpoint that is not necessarily represented by endoscopic mucosal healing. Several studied have demonstrated the lack of histological remission in UC increases risk of relapse, hospitalizations and the risk of colorectal neoplasia. There are limited studies evaluating fecal calprotectin as a non-invasive measure for histological remission and identification of optimal cut-off levels.
Our study focuses on identifying an optimal cut-off level for FC for histological healing in UC patients. Based on our data, we were able to demonstrate that an FC level ≤ 60 μg/g accurately was able to identify histological healing in UC patients. Our study, however, needs to be formally validated in a larger cohort, but shows how FC can potentially be used in the treat-to-target paradigm. The use of a non-invasive marker such as FC will minimize need for frequent endoscopy/imaging, but can accurately identify patients in remission and potentially can help optimize medical therapy.
What do patients need to know?
Newer therapies from those that are currently available to those on the horizon will require the need for proper surveillance of patients with respect to remission. Currently, the gold standard is endoscopy but this can be costly and invasive, which limits its use for frequent assessments. With our preliminary study, we demonstrated that using non-invasive markers such as fecal calprotectin (FC) can accurately assess for “deeper” remission. With further validation, the use of FC could be used to readily and frequently evaluate for control of disease activity while on medication therapy without the recurrent need for endoscopy, minimizing patient discomfort and costs.
Anish Patel, DO, Carl R. Darnall Army Medical Center
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