Changes in Crohnʼs Disease Activity Index and C-reactive Protein Levels During Anti-MAP Therapy (2009)

Purpose: Crohn's Disease Activity Index (CDAI) and C-reactive protein (CRP) are widely used parameters to evaluate treatment effect in Crohn's disease. Anti-Mycobacterium avium paratuberculosis (Anti-MAP) therapy comprising rifabutin, clarithromycin and clofazimine has been shown to be effective in achieving remission in 66% of patients at 16 weeks 1. The time-course responses of individual CDAI components and CRP levels in response to anti-MAP therapy are unknown. Aim: To observe the time-course responses of CDAI components and CRP levels during anti-MAP therapy in moderate-to-severe Crohn's disease. Methods: Fifteen patients with active moderate-to-severe Crohn's disease failing other treatments were commenced on Anti-MAP therapy (ramp-up dosing), with CDAI and CRP measured at baseline and during treatment whilst on concomitant medications including mesalazine, corticosteroids and/or immunosuppressives. Analysis of CRP levels and CDAI variables were performed at each follow-up visit to determine which disease-related variables responded the greatest during therapy. Results: A significant decrease in CDAI scores and CRP levels from baseline to Week 51 was observed. 100% (15/15) of patients responded to anti-MAP therapy and experienced a decrease of 70 points from their baseline CDAI score (mean 354.5 ±161.9), with a mean response time of 6.8 ± 4.8 weeks. 12/15 patients (80%) experienced a decrease of 100 points from their baseline CDAI score and a response time of 7.0 ± 5.2 weeks. A decrease in CRP levels from a baseline level of 48 ± 75 mg/L to 12.02 ± 16 and 15.7±18.7 mg/L was observed in each group respectively whilst on anti-MAP therapy. All patients achieved remission at 16 ± 4.9 weeks, defined as a CDAI score < 150. In 13 of the 15 patients who experienced a CDAI of < 150 throughout treatment (26-51 wks), the time to achieve remission was 18.3 ± 9.2 weeks. A reduction in the number of liquid motions occurred from a mean baseline score of 88.7 ± 87.5 to a mean final score of 14.9 ±18.8, a reduction of 83.2%. A reduction in abdominal pain severity occurred from a mean baseline score of 67 ± 36.9 to a mean final score of 8 ± 14.1, an 88.0% reduction. An improvement in general well-being also occurred from a mean baseline score of 127.4 ± 60.9 to 17.3 ± 23.5, an improvement of 86.4%. Conclusion: Anti-MAP therapy resulted in a rapid and sustained decrease in CDAI scores, with a paralleled decrease in CRP levels. The first 3 CDAI variables comprising liquid stool, abdominal pain and general well-being showed the greatest response during therapy. 1. Selby W, Pavli P, Crotty B, et al. Gastroenterology 2007;132:2313-2319. Disclosure: Prof T. Borody - Director, Proprietary owner - Centre for Digestive Diseases, Stockholder - Giaconda Ltd. Jordana Campbell - Employee of the Centre for Digestive Diseases. Margaux Torres - Employee of the Centre for Digestive Diseases. Lauren A. Hills - Employee of the Centre for Digestive Diseases. Sahisha Ketheeswaran - Employee of the Centre for Digestive Diseases. Sharyn Leis- Employee of the Centre for Digestive Diseases. Gerald Pang - Consultant for the Centre for Digestive Diseases.