Faecal calprotectin and lactoferrin are reliable surrogate markers of endoscopic response during Crohn's disease treatment

Abstract

Objective. Serial monitoring data for faecal calprotectin and lactoferrin during Crohn's disease (CD) therapy are scarce. The aim of this research was to study the behaviour of faecal biomarkers during CD therapy. Material and methods. Adult CD patients (n = 19) needing therapy enhancement were prospectively recruited. The simple endoscopic score for Crohn's disease (SES-CD) was administered before and 4–6 months after therapy. At baseline and at 2–3 and 4–6 months, patients provided faecal samples for measurements of calprotectin and lactoferrin. Results. Of 19 patients, seven were endoscopic responders, three were partial responders and nine were non-responders. During therapy, both faecal-biomarker concentrations decreased significantly in responders: median calprotectin from 1282 μg/g (range 156–2277 μg/g) to 73 μg/g (range 7–2222; P = 0.005) and lactoferrin from 233 μg/g (range 2.8–802 μg/g) to 0.0 μg/g (range 0.0–420 μg/g; P = 0.005), and these changes correlated significantly with changes in the SES-CD. In non-responders, changes in faecal biomarkers were non-significant: calprotectin decreased from 1017 μg/g (range 53–3928 μg/g) to 223 μg/g (range 35–15 330 μg/g; P = 0.594) and lactoferrin from 22.5 μg/g (range 2.1–629 μg/g) to 13.0 μg/g (range 3.5–1259 μg/g; P = 0.515). Conclusions. The faecal neutrophil-derived proteins calprotectin and lactoferrin are reliable surrogate markers of mucosal improvement. Endoscopic responders achieved normalization of faecal biomarkers, whereas in the majority of endoscopic non-responders these markers remained abnormal.