BACKGROUND: Crohn's disease (CD) prevalence is rising globally. Early optimal therapy is key to achieving remission. A Clinical Decision Support Tool (CDST) predicts outcomes for CD patients on vedolizumab, though its broader applicability is uncertain. AIMS: To assess whether the CDST can identify CD patients at highest risk for health-care utilization following biologic initiation. METHODS: A retrospective chart review was conducted at a tertiary care referral centre. Patients ≥18 years with CD initiating biologic therapy between January 1, 2015 and December 31, 2023 were included. CDST scores were assigned based on baseline albumin and C-Reactive protein (CRP), prior bowel surgery, anti-TNF therapy and fistulizing disease. Scores ≤19 indicated a low/intermediate likelihood of response to therapy, while scores >19 indicated a high likelihood. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox regression models adjusting confounding factors. RESULTS: Among the 137 CD patients that were included, 55 were in the low/intermediate group and 82 in the high group. When compared to those with high CDST score, those with low/intermediate scores had shorter time to CD-related hospitalization (28.6 vs. 66.4 weeks, HR 3.6, 95% CI, 1.4-9.1, p<0.01), ED visit (29.9 vs. 55.3 weeks, HR 3.1, 95% CI, 1.4-6.9, p=0.01) and biologic discontinuation (83.4 vs. 123.6 weeks, HR 2.7, 95% CI, 1.2-6.4, p<0.01). CONCLUSION: CDST scores may predict health care utilization and discontinuation of biologic therapy in CD patients. This tool may help clinicians identify individuals at higher risk for treatment failure, enabling personalized management and closer monitoring.
SAFAR et al. (Mon,) studied this question.