Real-time tool to display the predicted disease course and treatment response for children with Crohn's disease.
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.
Siegel
Corey A
CA
Dartmouth-Hitchcock Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. corey.a.siegel@hitchcock.org
Siegel
Lori S
LS
Hyams
Jeffrey S
JS
Kugathasan
Subra
S
Markowitz
James
J
Rosh
Joel R
JR
Leleiko
Neal
N
Mack
David R
DR
Crandall
Wallace
W
Evans
Jonathan
J
Keljo
David J
DJ
Otley
Anthony R
AR
Oliva-Hemker
Maria
M
Farrior
Sharmayne
S
Langton
Christine R
CR
Wrobel
Iwona T
IT
Wahbeh
Ghassan
G
Quiros
J Antonio
JA
Silber
Gary
G
Bahar
Ron J
RJ
Sands
Bruce E
BE
Dubinsky
Marla C
MC
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D015233:Models, Statistical; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D007155:Immunologic Factors
Risk Anal. 2009 Jan;29(1):121-36
18826414
Gastroenterology. 2000 Oct;119(4):895-902
11040176
Clin Gastroenterol Hepatol. 2008 Oct;6(10):1105-11
18619921
Gastroenterology. 2007 Sep;133(3):769-79
17628557
Am J Public Health. 2006 Mar;96(3):488-94
16449587
Gastroenterology. 2006 Mar;130(3):650-6
16530505
Gut. 2007 Oct;56(10):1394-403
17456509
Gastroenterology. 2007 Mar;132(3):863-73; quiz 1165-6
17324398
Med Decis Making. 2007 Sep-Oct;27(5):696-713
17873259
Gut. 2005 Feb;54(2):237-41
15647188
Lancet. 2008 Feb 23;371(9613):660-667
18295023