Noninvasive biomarkers as surrogate predictors of clinical and endoscopic remission after infliximab induction in patients with refractory ulcerative colitis

Elham A Hassan, Haidi K Ramadan, Ali A Ismael, Khaled F Mohamed, Madiha M El-Attar, Ihab Alhelali, Elham A Hassan, Haidi K Ramadan, Ali A Ismael, Khaled F Mohamed, Madiha M El-Attar, Ihab Alhelali

Abstract

Background/aims: Treatment of refractory ulcerative colitis (UC) is a clinical challenge, and after biological therapy, monitoring clinical and endoscopic responses is fundamental. We aimed to investigate and compare the predictive power of different noninvasive parameters for clinical remission and mucosal healing after infliximab induction therapy in refractory UC patients.

Patients and methods: Serum and fecal biomarkers, including hemoglobin, white blood cells, erythrocyte sedimentation rate, C-reactive protein (CRP), and fecal calprotectin (FC), and colonoscopy were assessed in 44 patients with refractory UC before and after (week 12) infliximab induction. Clinical and endoscopic responses were measured by clinical Mayo score and endoscopic Mayo subscore, respectively.

Results: After infliximab induction, 54.5% and 65.9% had clinical remission and mucosal healing, respectively. Post-induction CRP and FC were significantly lower in clinical responders versus nonresponders (P = 0.01 and 0.001, respectively) and in patients with mucosal healing than without (P < 0.001). Among all the parameters tested, FC had the best predictive value of clinical remission [Area under the curve (AUC = 0.826)] and mucosal healing (AUC = 0.949). Post-induction FC had 87.5% sensitivity and 89% specificity (cut-off <100 μg/g) for predicting clinical remission and 89.7% sensitivity and 93.3% specificity (cut-off <58 μg/g) for predicting mucosal healing.

Conclusions: Post-infliximab induction FC can be used as a surrogate marker for predicting clinical remission and mucosal healing in refractory UC patients.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Laboratory parameters at baseline (Week 0) and after infliximab induction (follow-up at week 12). Variable at baseline (Week 0); Variable at follow-up (Week 12). Hb: Hemoglobin; WBC: White blood cells; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; FC: Fecal calprotectin
Figure 2
Figure 2
Area under the receiver operating characteristic curve (AUC) of laboratory parameters to predict clinical (a) and endoscopic (b) remission. FC had the highest AUC in predicting clinical remission (AUC = 0.826) and mucosal healing (AUC = 0.949). Hb: Hemoglobin; WBC: White blood cells; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; FC: Fecal calprotectin

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