Predicting pediatric inflammatory bowel disease remission utilizing a clinical decision support tool.
AI interpretation is pending for this paper.
Open original publication →What the AI sees
Not AI summarized yet.
Research significance
Pending deeper interpretation.
Source abstract
OBJECTIVES: A clinical decision support tool (CDST) endorsed by The American Gastroenterological Association predicts likelihood of inflammatory bowel disease (IBD) remission in adults based on the advanced therapy selected. In children who are given these same therapies, predictors of response may differ from those in adults. The aim of this study is to establish the CDST's ability to predict remission in a pediatric IBD population treated with non-anti-tumor necrosis factor (TNF) biologics. METHODS: A single center retrospective review of IBD patients 2-21 years of age who received either vedolizumab (VDZ) or ustekinumab (UST) between 2018 and 2023 was performed. Subjects were either biologic naïve or had prior anti-TNF exposure. Baseline clinical characteristics were used to generate a CDST score. This score was compared to week 52 outcomes after starting VDZ or UST in the full cohort, divided by IBD diagnosis, and medication choice. A dichotomized cut-off score of > or ≤19 indicating high or low probability of steroid free clinical remission (SFR) was then used in the same analysis as well as groups separated by anti-TNF exposure status. RESULTS: One hundred seventy subjects were included. SFR at Week 52 of VDZ or UST was achieved in 108/170 (64%) of patients. SFR at Week 52 was significantly associated with CDST score in the full cohort (p < 0.001), in UC (p = 0.0015) and in CD (p = 0.043) subjects. SFR at Week 52 was significantly associated with dichotomized CDST cut-off score in full cohort (p < 0.001), UC (p < 0.005) and CD (p < 0.021) subjects. CDST score >19 had high sensitivity for predicting SFR at Week 52 in full cohort and when separated by disease state. In the anti-TNF exposed cohort, SFR at Week 52 was significantly associated with dichotomized CDST cut-off score of 19 (p < 0.0037). No significant association was seen in anti-TNF naive cohort. When separated by medical therapy, significant association seen with both continuous (p < 0.001) and dichotomized (p < 0.001) CDST score and SFR in patients treated with VDZ. No significant association was seen with patients treated with UST. CONCLUSIONS: The CDST appears to have applicability for predicting week 52 SFR in children with UC or CD. CDST score of >19 is a highly sensitive cut point for predicting SFR in our pediatric IBD patients.