Real-time tool to display the predicted disease course and treatment response for children with Crohnʼs disease
Year: 2010
Type: article
Abstract: BACKGROUND: Immunomodulators and biologics are effective treatments for children with Crohn's disease (CD). The challenge of communicating the anticipated disease course with and without therapy to patients and parents is a barrier to the timely use of these agents. The aim of this project was to develop a tool to graphically display the predicted risks of CD and expected benefits of therapy. METHODS: Using prospectively collected data from 796 pediatric CD patients we developed a model using system dynamics analysis (SDA). The primary model outcome is the probability of developing a CD-related complication. Input variables include patient and disease characteristics, magnitude of serologic immune responses expressed as the quartile sum score (QSS), and exposure to medical treatments. RESULTS: Multivariate Cox proportional analyses show variables contributing a significant increase in the hazard ratio (HR) for a disease complication include female gender, older age at diagnosis, small bowel or perianal disease, and a higher QSS. As QSS increases, the HR for early use of corticosteroids increases, in contrast to a decreasing HR with early use of immunomodulators, early or late biologics, and early combination therapy. The concordance index for the model is 0.81. Using SDA, results of the Cox analyses are transformed into a simple graph displaying a real-time individualized probability of disease complication and treatment response. CONCLUSIONS: We have developed a tool to predict and communicate individualized risks of CD complications and how this is modified by treatment. Once validated, it can be used at the bedside to facilitate patient decision making.
Source: Inflammatory Bowel Diseases
DOI: 10.1002/ibd.21386
Authors: Corey A. Siegel, Lori S. Siegel, Jeffrey S. Hyams, Subra Kugathasan, James Markowitz, Joel R. Rosh, Neal Leleiko, David R. Mack, Wallace Crandall, Jonathan Evans, David J. Keljo, Anthony R. Otley, Maria Oliva-Hemker, Sharmayne Farrior, Christine R. Langton, Iwona T. Wrobel, Ghassan Wahbeh, J. Antonio Quiros, Gary Silber, Ron J. Bahar, Bruce E. Sands, Marla C. Dubinsky
Institutions: Dartmouth College, Dartmouth–Hitchcock Medical Center, Connecticut Children's Medical Center, Emory University, Children's Healthcare of Atlanta, Schneider Children's Hospital, Morristown Medical Center, Hasbro Children's Hospital, Children's Hospital of Eastern Ontario, Nationwide Children's Hospital, Nemours Children’s Clinic, Nemours Children's Clinic, University of Pittsburgh, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Dalhousie University, Johns Hopkins University, Johns Hopkins Hospital, Cedars-Sinai Medical Center, Phoenix Children's Hospital, Alberta Children's Hospital, Seattle Children's Hospital, California Pacific Medical Center, Harvard University, Massachusetts General Hospital
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2011302801