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Predicting pediatric inflammatory bowel disease remission utilizing a clinical decision support tool
Erica Rabinovich1, James F Markowitz1, Jane Cerise1,2
1Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA.
Insights
The clinical decision support tool (CDST) effectively predicts steroid-free remission (SFR) in pediatric inflammatory bowel disease (IBD) patients treated with vedolizumab or ustekinumab. A CDST score over 19 shows high sensitivity for predicting week 52 SFR.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Clinical Decision Support Systems
Background:
- The American Gastroenterological Association's CDST predicts IBD remission in adults based on advanced therapy.
- Predictors of treatment response in pediatric IBD may differ from adults.
- Non-anti-tumor necrosis factor (TNF) biologics are increasingly used in pediatric IBD.
Purpose of the Study:
- To evaluate the predictive ability of the CDST for remission in pediatric IBD patients.
- To assess CDST performance in children treated with vedolizumab (VDZ) or ustekinumab (UST).
- To determine if CDST applicability extends to non-anti-TNF biologic therapies in pediatric IBD.
Main Methods:
- Retrospective review of 170 pediatric IBD patients (2-21 years) treated with VDZ or UST.
- Analysis of baseline characteristics to generate CDST scores.
- Comparison of CDST scores with week 52 steroid-free clinical remission (SFR) outcomes, stratified by disease type and prior anti-TNF exposure.
Main Results:
- 64% of patients achieved SFR at week 52.
- CDST score significantly predicted SFR in the overall cohort, ulcerative colitis (UC), and Crohn's disease (CD) groups (p<0.001).
- A CDST score >19 demonstrated high sensitivity for predicting SFR, particularly in patients previously treated with anti-TNF therapies and those on VDZ.
Conclusions:
- The CDST shows applicability in predicting week 52 SFR in pediatric UC and CD patients.
- A CDST score exceeding 19 is a highly sensitive indicator for predicting SFR in this pediatric IBD population.
- The tool's predictive value is notable in anti-TNF exposed patients and those receiving VDZ.
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.
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