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Increased mesalamine dose reduced fecal calprotectin in patients with quiescent UC
Increasing mesalamine dose by 2.4 grams daily in patients with quiescent ulcerative colitis reduced fecal calprotectin to levels associated with lower relapse rates in a recent study.
"We have identified a novel way to use fecal calprotectin which could potentially translate into better patient outcomes," Mark T. Osterman, MD, University of Pennsylvania, Perelman School of Medicine, told Healio.com.
Osterman and colleagues conducted a multicenter open-label randomized controlled trial (RCT) from October 2008 to March 2012 to determine whether an increased dose of multimatrix mesalamine (5-aminosalicylate) would reduce fecal calprotectin (FC) levels in ulcerative colitis (UC) patients who were in remission but had elevated FC. FC levels were measured at weeks 0, 6 and 12 in all patients, and follow-ups via telephone continued at 24, 36 and 48 weeks.
Mark T. Osterman
Of 119 patients screened, 52 who met inclusion criteria were randomly assigned to a control group that continued current mesalamine regimen (group A; n=26) or a group whose dose increased by 2.4 g daily for 6 weeks (group B; n=26). Median FC levels at baseline were 214 mcg/g (IQR, 80-675) for group A and 174 mcg/g (IQR, 67-439) for group B (P=.42).
Continued remission at 6 weeks with FC levels less than 50 mcg/g was achieved by one patient in group A and seven patients in group B (P=.0496). A higher proportion of group B patients had FC levels below 100 mcg/g (P=.04) and 200 mcg/g (P=.005) compared with group A. Time to relapse was shorter in patients with FC levels of at least 200 mcg/g compared with those with lower levels (P=.01).
“Our study adds to the evidence supporting FC concentration as a valid biomarker for UC,” the researchers wrote. “Perhaps more importantly, our results offer a novel way to use FC testing to positively impact outcomes in UC.”
Disclosure: See the study for a full list of relevant financial disclosures.