炎症性肠病临床决策支持工具的校准、临床实用性和特异性。

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Clinical Gastroenterology and Hepatology Pub Date : 2024-10-24 DOI:10.1016/j.cgh.2024.09.020
Dahham Alsoud, João Sabino, Marc Ferrante, Bram Verstockt, Séverine Vermeire
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引用次数: 0

摘要

背景和目的:目前已开发出临床决策支持工具(CDST),用于预测克罗恩病(CD)和溃疡性结肠炎(UC)患者对韦多珠单抗(VDZ)和乌斯特库单抗(UST)的反应。除了评估它们的鉴别性能外,我们的研究还旨在评估它们的校准、临床实用性和特异性:我们纳入了280名开始使用VDZ的CD和218名UC患者,以及194名开始使用UST的CD患者。我们通过比较 CDST 预测的反应概率组间的有效率来评估其鉴别性。校准曲线和决策曲线分析评估了 VDZ-CDST 的校准和临床实用性。此外,我们还考察了 UST-CDST 和 VDZ-CDST 在分配开始 UST 的 CD 患者的应答概率组别时的一致性:在整个队列中,CDST 将 7.2%、50.0% 和 42.8% 的患者分别分配到低、中和高反应概率组。VDZ-CDSTs 组在临床和内镜反应率及缓解率方面表现出显著差异,而 UST-CDST 组仅在临床缓解率方面表现出显著差异。虽然VDZ-CDSTs高估了临床缓解率,但它们更准确地预测了无需手术或剂量升级的VDZ持续率。与根据经验对所有患者进行VDZ治疗相比,VDZ-CDSTs在选择无需手术或剂量升级即可继续VDZ治疗的患者方面产生了更高的净收益。最后,UST-CDST 和 VDZ-CDST 在预测反应方面的一致性为 73.7%:结论:VDZ-CDST能明显区分患者对VDZ的反应,与对所有患者进行经验性治疗相比,VDZ-CDST更有利于识别无需手术或剂量升级即可继续治疗的患者。
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Calibration, Clinical Utility and Specificity of Clinical Decision Support Tools in Inflammatory Bowel Disease.

Background and aims: Clinical decision support tools (CDSTs) have been developed to predict response to vedolizumab (VDZ) and ustekinumab (UST) in Crohn's disease (CD) and ulcerative colitis (UC). In addition to assessing their discrimination performance, our study aimed to evaluate their calibration, clinical utility and specificity.

Methods: We included 280 CD and 218 UC patients initiating VDZ, and 194 CD patients initiating UST. We assessed discrimination by comparing rates of effectiveness outcomes between response probability groups forecasted by CDSTs. Calibration curves and decision curve analysis evaluated the calibration and clinical utility of VDZ-CDSTs. Additionally, we examined the agreement between UST-CDST and VDZ-CDST in assigning response probability groups among CD patients starting UST.

Results: In the overall cohort, CDSTs allocated 7.2%, 50.0% and 42.8% of the patients to the low, intermediate and high response probability groups, respectively. VDZ-CDSTs groups demonstrated significant differences in the rates of clinical and endoscopic response and remission, while UST-CDST groups showed significant discrimination only for clinical remission. Although VDZ-CDSTs overestimated clinical remission rates, they more accurately predicted rates of VDZ persistence without need for surgery or dose escalation. Compared to empirically treating all patients with VDZ, VDZ-CDSTs yielded higher net benefits in selecting patients who would continue VDZ without need for surgery or dose escalation. Finally, the agreement between UST-CDST and VDZ-CDST in predicting response was 73.7%.

Conclusion: VDZ-CDSTs significantly discriminated response to VDZ and were more beneficial in identifying patients who would continue therapy without requiring surgery or dose escalation, compared to treating all patients empirically.

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来源期刊
CiteScore
16.90
自引率
4.80%
发文量
903
审稿时长
22 days
期刊介绍: Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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