Prediction of treatment outcome and relapse in inflammatory bowel disease

ABSTRACT

Introduction: Prediction of treatment outcome and clinical relapse in patients with inflammatory bowel disease (IBD), either ulcerative colitis (UC) or Crohn’s disease (CD), is particularly important because therapeutics for IBD are not always effective and patients in remission could frequently relapse. Because undergoing endoscopy for the purpose is sometimes invasive and burdensome to patients, the performance of surrogate biomarkers has been investigated.

Areas covered: We particularly featured the performance of patient symptoms, blood markers including C-reactive protein (CRP), fecal markers including fecal calprotectin (Fcal) and fecal immunochemical test (FIT) for prediction of endoscopic mucosal healing (MH) and prediction of relapse. Studies of other modalities and therapeutic drug monitoring (TDM) have also been explored.

Expert opinion: Meticulous evaluation of patient symptoms could be predictive for MH in UC. CRP and Fcal may be accurate in prediction of MH of CD when MH is evaluated throughout the entire intestine including the small bowel. Repeated measurements of fecal markers including Fcal and FIT in patients with clinical remission would raise predictability of relapse. Prediction of treatment outcome by monitoring with blood markers including CRP, fecal markers including Fcal, and TDM has frequently been performed in recent clinical trials and shown to be effective.

KEYWORDS:

• C-reactive protein
• Crohn’s disease
• fecal calprotectin
• fecal immunochemical test
• therapeutic drug monitoring
• ulcerative colitis

Article Highlights

• Accurate evaluation of treatment outcome and prediction of relapse is particularly important in clinical management of IBD patients. Because endoscopy is somewhat invasive, surrogate biomarkers for mucosal status have been evaluated.

• Meticulous evaluation of patient symptoms, particularly rectal bleeding, could be predictive for MH in UC. In CD, in contrast, prediction for MH and relapse with patient symptoms is difficult partly because of the presence of small bowel lesions.

• As for blood markers, in UC, normal CRP is a necessary condition but far from a sufficient condition for MH. In CD, CRP might be relatively accurate in predicting MH when meticulous endoscopic evaluation throughout the intestine was performed. CRP could not be used for prediction of relapse in general situation of IBD clinical practice.

• Fcal showed relatively good performance for MH in UC. Fcal might be accurate in prediction of MH in CD when MH was evaluated throughout the entire intestine. The ability of Fcal to predict relapse in IBD was not so prominent but repeated measurements of Fcal in patients with clinical remission would raise predictability.

• FIT appears to be more sensitive than Fcal in predicting MH with more strict definition. The lower cost of FIT than Fcal enables frequent measurements in quiescent IBD patients at hospital visits and would lead to more meticulous clinical control.

• Prediction of treatment outcome by monitoring with blood markers including CRP, fecal markers including Fcal, and TDM has frequently been performed in recent clinical trials and shown to be effective.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.