DOP038. Faecal calprotectin measurement and infliximab trough levels predict therapeutic evolution CD patients in clinical remission
Bibliographic record
Abstract
The deep remission notion (clinical remission and mucosal healing) is an important objective for patients under treatment. The appearance of inflammation and pharmacological biomarkers could be a non-harmful way of predicting the evolution of Crohn's disease (CD). The aim of our study was to offer a predictive model for relapse in CD patients presenting clinical remission undergoing infliximab (IFX) treatment. Methods: It was a prospective monocentric study that included all CD patients on IFX maintenance treatment (5mg/kg) and in clinical remission (CDAI< 150) for at least 16 weeks, between 2011 and 2014. On the day of the IFX infusion, all of these patients underwent a faecal calprotectin assay (Buhlmann technique), a CRP assay and pharmacological assays of IFX (ELISA , Theradiag). TLI ( > 2g/ ml) were considered therapeutic as well as CRP levels < 5mg/l and faecal calprotectin levels < 250 mg/g of stools. All of the patients included were followed up for a minimum of nine months. A CDAI score was calculated at each IFX infusion. A patient was defined in loss of response to IFX (LOR) when the CDAI was above 220, resulting in a change of treatment deemed necessary by the physician (IFX optimisation, change of medical treatment including the use of corticosteroids, surgery). Results: 119 patients (mean age: 34 years, M:F sex ratio 1.2, mean duration of the disease 7.8 years) were included. The mean followup period was 20.4 months. 17% of the patients were on combotherapy (IFX and azathioprine). During follow-up, 37 patients (31.1%) out of the 119 relapsed, 78% within the first 6 months (mean period: 4.6 months). While the clinical characteristics of the relapsed and non-relapsed patients were similar, a univariate analysis isolated four significant factors predicting LOR: (CRP > 5mg/l (p=0.043), ATI > 20ng/ml (p< 0.001), LTI > 2 g/ml (p< 0.001) and calprotectin > 250 g/g stools (p<0.001)). After logistic regression, two independent factors were linked to a loss of clinical response: LTI < 2g/ml (OR: 4,34 ; 95% CI: 1.28-10.7; p=0.001) and faecal calprotectin > 250g/g stools (OR: 3.5; 95% CI: 1.5-8.7; p=0.001). In light of these results, a training cohort of 55 patients was isolated randomly in order to implement a predictive model for LOR in patients on IFX and in clinical remission. The combination of calprotectin > 250g/g stools and TLI < 2g/ml enabled to be predicted LOR in 95% of the cases within 6 months. This model was validated on the test cohort of 64 patients with a PPV of 95% and an NPV of 95%.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".