Development of a Simple, Serum Biomarker-based Model Predictive of the Need for Early Biologic Therapy in Crohn’s Disease
| العنوان: | Development of a Simple, Serum Biomarker-based Model Predictive of the Need for Early Biologic Therapy in Crohn’s Disease |
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| المؤلفون: | Tony Long, Anna Wan, Declan Connoley, Maria Bishara, Danny Con, Peter R. Gibson, Abhinav Vasudevan, James A Rickard, Neetima Joshi, Daniel R. van Langenberg, Nina Parthasarathy, Raphael P. Luber, Miles P. Sparrow |
| المصدر: | Journal of Crohn's and Colitis. 15:583-593 |
| بيانات النشر: | Oxford University Press (OUP), 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Cost effectiveness, Fistula, Disease, 03 medical and health sciences, 0302 clinical medicine, Crohn Disease, Predictive Value of Tests, Albumins, Internal medicine, Humans, Immunologic Factors, Medicine, Abscess, Retrospective Studies, Biological Products, Crohn's disease, business.industry, Proportional hazards model, Remission Induction, Australia, Gastroenterology, Area under the curve, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, C-Reactive Protein, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, business, Biomarkers |
| الوصف: | Background Early or first-line treatment with biologics, as opposed to conventional immunomodulators, is not always necessary to achieve remission in Crohn’s disease [CD] and may not be cost-effective. This study aimed to develop a simple model to predict the need for early biologic therapy, in order to risk-stratify CD patients and guide initial treatment selection. Methods A model-building study using supervised statistical learning methods was conducted using a retrospective cohort across two tertiary centres. All biologic-naïve CD patients who commenced an immunomodulator between January 1, 2004 and December 31, 2016, were included. A predictive score was derived using Cox regression modelling of immunomodulator failure, and was internally validated using bootstrap resampling. Results Of 410 patients [median age 37 years, 47% male, median disease duration 4.7 years], 229 [56%] experienced immunomodulator failure [39 required surgery, 24 experienced a new stricture, 44 experienced a new fistula/abscess, 122 required biologic escalation] with a median time to failure of 16 months. Independent predictors of treatment failure included raised C-reactive protein [CRP], low albumin, complex disease behaviour, younger age, and baseline steroids. Highest CRP and lowest albumin measured within the 3 months preceding immunomodulator initiation outperformed baseline measurements. After model selection, only highest CRP and lowest albumin remained and the resultant Crohn’s Immunomodulator CRP-Albumin [CICA] index demonstrated robust optimism-corrected discriminative performance at 12, 24, and 36 months (area under the curve [AUC] 0.84, 0.83, 0.81, respectively). Conclusions The derived CICA index based on simple, widely available markers is feasible, internally valid, and has a high utility in predicting immunomodulator failure. This requires external, prospective validation. |
| تدمد: | 1876-4479 1873-9946 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::40c771458268f30ec1ddad6eb355b470 https://doi.org/10.1093/ecco-jcc/jjaa194 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....40c771458268f30ec1ddad6eb355b470 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 18764479 18739946 |
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