DOP038. Faecal calprotectin measurement and infliximab trough levels predict therapeutic evolution CD patients in clinical remission
Bibliographic record
Abstract
Background: 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 ( > 2µg/ 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 µg/ml (p< 0.001) and calprotectin > 250 µg/g stools (p<0.001)).After logistic regression, two independent factors were linked to a loss of clinical response: LTI < 2µg/ml (OR: 4,34 ; 95% CI: 1.28-10.7;p=0.001) and faecal calprotectin > 250µg/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 > 250µg/g stools and TLI < 2µg/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%.Conclusions: In IFX-treated CD patients and in clinical remission, a combination of TLI (< 2µg/ml) and faecal calprotectin (>250µg/g of stools) enable the prediction of LOR within 6 months in 95% of cases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".