Normalization of Fecal Calprotectin Within 12 Months of Diagnosis is Associated with Reduced Risk of Disease Progression in Patients with Crohn’s Disease

ABSTRACT Background Aims The level of fecal calprotectin (FC) correlates with endoscopic evidence of inflammation in Crohn's disease (CD). A treat-to-target algorithm for patients with CD, that incorporates FC, outperforms a treatment strategy based on symptoms alone in induction of mucosal healing at 12 months. We investigated whether normalization of FC within 12 months of diagnosis of CD is associated with a reduction in disease progression. Methods We performed a retrospective cohort study at a tertiary IBD centre in the United Kingdom. We identified all incident cases of CD diagnosed from 2005 through 2017. Patients with a FC measurement ≥250 μg/g at diagnosis who also had at least 1 follow-up FC measurement within the first 12 months of diagnosis and >12 months of follow up were included. The last FC measurement within 12 months of diagnosis was used to determine normalization (cut-off Results A total of 375 patients out of 1368 incident cases were included, with a median follow up of 5.3 years (interquartile range, 3.1–7.4 years). Normalization of FC within 12 months of diagnosis was confirmed in 43.5% of patients. Patients with normalized levels of FC had a significantly lower risk of composite disease progression (hazard ratio [HR], 0.36; 95% CI, 0.24–0.53; P Conclusions Normalization of FC within 12 months of diagnosis is associated with a reduced risk of progression of CD.