Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Gut Liver. 2024 May 15;18(3):498-508. doi: 10.5009/gnl230022. Epub 2023 Nov 28.
BACKGROUND/AIMS: : The recent update on Selecting Therapeutic Targets in Inflammatory Bowel Disease initiative has added a decrease in fecal calprotectin (FC) to an acceptable range as an intermediate target for Crohn's disease (CD). We aimed to investigate whether postinduction FC could predict future persistent remission (PR) and endoscopic healing (EH) after 1 year of treatment with infliximab (IFX) in pediatric patients with CD.
: This multicenter retrospective observational study included pediatric patients with CD who were followed up for at least 1 year after starting IFX. The association of postinduction FC with PR and EH was investigated.
: A total of 132 patients were included in this study. PR and EH were observed in 71.2% (94/132) and 73.9% (82/111) of the patients, respectively. In multivariate logistic regression analysis, only the postinduction FC level was associated with PR (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.08 to 0.66; p=0.009). The FC levels at initiation of IFX and postinduction were significantly associated with EH (OR, 0.73; 95% CI, 0.53 to 0.99; p=0.044 and OR, 0.20; 95% CI, 0.06 to 0.49; p=0.002, respectively). According to the receiver operating characteristic curve analysis, the optimal cutoff level for postinduction FC associated with PR was 122 mg/kg, and that associated with EH was 377 mg/kg.
: Postinduction FC was associated with PR and EH after 1 year of treatment with IFX in pediatric patients with CD. Our findings emphasize the importance of FC as an intermediate target in the treat-to-target era.
背景/目的：炎症性肠病治疗靶点选择的最新进展将粪便钙卫蛋白（FC）降低到可接受范围内作为克罗恩病（CD）的中间目标。我们旨在研究诱导后 FC 是否可以预测接受英夫利昔单抗（IFX）治疗 1 年后儿科 CD 患者的持续缓解（PR）和内镜愈合（EH）。
这项多中心回顾性观察性研究纳入了至少接受 IFX 治疗 1 年以上的 CD 患儿。研究了诱导后 FC 与 PR 和 EH 的关系。
本研究共纳入 132 例患者。71.2%（94/132）和 73.9%（82/111）的患者分别达到 PR 和 EH。多变量 logistic 回归分析显示，仅诱导后 FC 水平与 PR 相关（优势比 [OR]，0.26；95%置信区间 [CI]，0.08 至 0.66；p=0.009）。IFX 起始时和诱导后 FC 水平与 EH 显著相关（OR，0.73；95%CI，0.53 至 0.99；p=0.044 和 OR，0.20；95%CI，0.06 至 0.49；p=0.002）。根据受试者工作特征曲线分析，诱导后 FC 与 PR 相关的最佳截断值为 122mg/kg，与 EH 相关的最佳截断值为 377mg/kg。
诱导后 FC 与 CD 患儿接受 IFX 治疗 1 年后的 PR 和 EH 相关。我们的研究结果强调了 FC 作为靶向治疗时代中间目标的重要性。
