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Calprotein Readings.

Just wondered if anyone could offer a view on this.

So my son has been diagnosed with Crohns and we have recently started biologicsto go with azathioprine as aza on its own didn’t work.

The great news is tummy aches stopped and his calprotein result went from 1800 to 125.

We had a recent calprotein test, hoping it would now be below the 80 mark, but it’s risen to 147.

My question is, does this figure need to get below the 80, or do Crohns patients often have continual figures above the 80?

We are obviously delighted it has gone in the right direction initially, but wondered if the docs have to maybe increase does to get below the 80 or just accept an inflated figure that wasn’t anywhere near as bad as it was before?
 

my little penguin

Moderator
Staff member
Fecal cal can vary during a single day
Typically takes months to go all the way down
Some docs like below 150
Some like below 50
As long as the meds are working
It will probably be a watch and wait game

My kiddos is below 15 consistently now for years
When it’s above 100 we know things are off

Also depends on disease location
Small intestine lower numbers (above 100) tend to get a look by Gi
Vs large intestine higher numbers in the 200-300 get more of an eyebrow raise

Glad he is responding
 
Knowing the testing dates is helpful and having one more data point can yield a nice trendline. When is the next testing date?

Great job getting it down to 125/147! Woot!
 
Knowing the testing dates is helpful and having one more data point can yield a nice trendline. When is the next testing date?

Great job getting it down to 125/147! Woot!
It’s in another 2 months, although we could get one sorted quicker.

It does appear azathioprine plus biologics have brought the inflammation down massively, although we are always worried about those two drugs together due to risk. But that’s another story
 

my little penguin

Moderator
Staff member
Can they do methotrexate plus biologics?
In the US at least the majority of pediatric Gi will not use aza plus biologics
They use mtx Plus biologics due to the risk of
Fatal T cell lymphoma when you combine aza plus biolgics in male teen boys

Hugs
 
Can they do methotrexate plus biologics?
In the US at least the majority of pediatric Gi will not use aza plus biologics
They use mtx Plus biologics due to the risk of
Fatal T cell lymphoma when you combine aza plus biolgics in male teen boys

Hugs
I am not sure, I suppose it’s worth the conversation. Do you know how long the Gis over there have decided against using those two together? Is it a recent situation do you know
 

my little penguin

Moderator
Staff member
Ds was dx 11 years ago and placed on 6-mp (sister drug to aza ) at age 8
The drug failed

A few years later (about 7 or 8 years ago )
Gi and rheumatologist completed put out eidetic in US due to TCell lymphoma and refused
To have any patients that were young males on aza/imuran/6-mp plus biologics

I think all the studies were being released at the time
 

crohnsinct

Well-known member
Fecal calprotectin can vary greatly so I wouldn't put much stock in a difference between 125 to 147. Like you said the result is a massive improvement. You will want to watch how it trends going forward. One of my daughters has all small bowel disease and while her pediatric GI has said he likes things under 150, we have watched it go up into the 200's and 300's and come right back down with no intervention what so ever.

Completely normal fecal calprotectin with Crohn's is achievable but certainly not the norm. I think you will find that generally speaking kids hover at or a little above the upper limit. This becomes more true the more severe your disease activity.

As for the Aza in the U.S., it is funny this topic comes up at this particular point because I just saw two case presentation with all the heavy hitter GI's and both patients were on aza and a couple pediatric GI's mentioned that while pediatric GI's have gone away from using it, it works really well and the risks are very very low….but the low risk is not a comfort to the one family that ends up unlucky. Of the 3 centers my daughters have been at, one used it and then stopped with their first case of hepatic T cell lymphoma, the second centered one case and is still using it, and the third doesn't use it but has never had a case.
 
Thanks for your comments. Literally waking up with the second point on my mind the last two nights.

Clearly the combination of azathioprine and adulimabab are clearly working, but there is a small risk that is keeping me awake.

I suppose it’s natural to worry yourself silly over it.

Thanks all for your comments, it’s great to see a positive change in my son with the meds, the difference is huge.
 
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