Results obtained through fecal immunochemical tests and levels of fecal calprotectin could help identify patients with ulcerative colitis with endoscopic markers of disease severity, according to study results.
Makoto Naganuma, MD, PhD, of the division of gastroenterology and hepatology at Keio University School of Medicine in Japan, and colleagues wrote that the two fecal markers could help predict which patients with UC in remission might be headed toward recurrence.
“There have been only a few large multicenter cohort studies on the efficacy of fecal biomarkers for clinical recurrence in patients with UC,” they wrote. “Furthermore, it remains unclear whether [fecal calprotectin (FCP)] or FIT levels can reflect extension of inflammation.”
Researchers analyzed data collected from 879 patients with UC enrolled at medical centers in Japan from 2015 to 2017. They used information on fecal biomarkers, endoscopic severity and other clinical factors to test the accuracy of the two tests in predicting patient outcomes.
In one cohort (n = 427), researchers assessed the diagnostic accuracy of FCP measurement and FIT to determine clinical severity based on Mayo score, and endoscopic remission based on Mayo endoscopic sub-score (MES) or UC endoscopic index of severity. They found there was no significant difference in the areas under the curve of FCP compared with FIT in distinguishing patients with a MES of no more than 1 from patients with a MES of at least 2, or in separating patients with a MES of 0 or no more than 1.
Investigators also followed patients in clinical remission for 12 months and explored the associations between FCP levels and FIT results with clinical recurrence. Of 405 patients in remission at baseline, 9.4% experienced a recurrence within 3 months and 22.2% experienced a recurrence within 12 months.
Naganuma and colleagues found that a FCP level of at least 146 mg/kg (HR = 4.84; 95% CI, 2.8–8.33) and a FIT level of at least 77 ng/mL (HR = 2.92; 95% CI, 1.76–4.83) were both independently associated with clinical recurrence within 12 months. Among patients who met the thresholds of FCP level and FIT result, 69% experienced a recurrence of UC within 12 months compared with 31.5% of patients who only met the FIT threshold (P < .001) and 30% of patients who met only the FCP threshold (P < .001).
Naganuma and colleagues wrote that FCP has an edge on assessing the entire length of the colon, but FIT might help identify the most severe inflammation in certain segments.
“Although FIT alone can be used in disease activity assessment, the potential discrepancy between these two tests with regard to disease extent in UC might justify dual testing in tandem,” they wrote. “This would be highly advantageous clinically to be able to identify not only the disease severity but where the disease is most active for guiding treatment management decisions.”– by Alex Young
Disclosures: Naganuma reports receiving non-financial support from Thermo Fisher Scientific, as well as lecture fees from Mochida Pharmaceutical and Thermo Fisher Scientific outside the submitted work. Please see the full study for all other authors’ relevant financial disclosures.