Journal of Crohn's and Colitis (2012) 6, 557-562

Fast and sharp decrease in calprotectin predicts remission by infliximab in anti-TNF naïve patients with ulcerative colitis

M. De Vos, O. Dewit, G. D'Haens, F. Baert, F. Fontaine, S. Vermeire, D. Franchimont, T. Moreels, D. Staessen, L. Terriere, B. Vander Cruyssen, E. Louis on behalf of BIRD

AIM: To evaluate the effect of infliximab induction therapy on calprotectin levels in patients with ulcerative colitis (UC).
PATIENTS AND METHODS: In this prospective study 53 patients with active UC from 17 centers were treated with infliximab therapy (5 mg/kg) at baseline, week 2, and week 6. Faecal calprotectin was measured every week. Sigmoidoscopies were performed at baseline, week 6 and week 10.
RESULTS: Median calprotectin levels decreased from 1260 (IQR 278.5- 3418 ) at baseline to 72.5 (IQR 18.5 - 463) at week 10 (pb0.001). After 10 weeks, infliximab therapy induced endoscopic remission and a decrease in calprotectin tob50 mg/kg or at least a 80% decrease from baseline level in 58% of patients. A significant and steep decrease of calprotectin levels was seen at week 2 for patients with an endoscopic remission at week 10 as compared to patients who did not show a remission. (pb0.001).
At week 10 an excellent correlation was found between endoscopic remission and clinical Mayo score reflected by an AUC of ROC analyses of 0.94 (0.87-1) and with calprotectin measurements (AUC 0.91 (0.81-1)): all patients with calprotectin levels b50 mg/kg, and a normal clinical Mayo score (=0) were in endoscopic remission.
CONSLUSIONS: Infliximab induces a fast and significant decrease of faecal calprotectin levels in anti-TNF naïve patients with ulcerative colitis predictive for remission of disease.