Model Forecasts Early Surgery Risk for Crohn's Disease Patients

Investigators identify several factors linked to early intestinal surgery for Crohn’s disease patients including smoking, BMI, and maximum bowel wall thickness.

A new prognostic model could help identify the one-year risk of Crohn’s disease-related intestinal surgery.

A team, led by Jia-Yin Yao, Department of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital of Sun Yat-Sen University, collected data from Crohn’s disease patients diagnosed between January 2012 and December 2016 and developed a prognostic model that predicts the one-year surgery risk for patients.

In the retrospective study, the investigators randomly stratified all the data into a training set and a testing set at a ratio of 8:2.

The team conducted multivariable logistic regression analysis with receiver operating characteristic curves constructed and the areas under the curve calculated to further validate with calibration and estimated discrimination. A nomogram was also developed.

The study included a total of 1002 patients, with a mean follow-up of 53.54±13.10 months.

Within 1 year following diagnosis, 24.25% of patients received intestinal surgery due to complications or disease relapse.

A number of variables were identified as independent significant factors associated with early intestinal surgery, including disease behavior (B2: OR, 6.693; P <.001; B3: OR, 14.405; P <.001), smoking (OR, 4.135; P <.001), body mass index (OR, .873, P <.001) and C-reactive protein (OR, 1.022; P = .001) at diagnosis, previous perianal (OR, 9.483; P <.001) or intestinal surgery (OR, 8.887; P <.001), maximum bowel wall thickness (OR, 1.965; P <.001), use of biologics (OR, .264; P <.001), and exclusive enteral nutrition (OR, .089; P <.001).

To further validate this, the investigators established the prognostic model, where the receiver operating characteristic curves and calculated areas under the curves (94.7%) confirmed an ideal predictive ability of the model with a sensitivity of 75.92% and specificity of 95.81%.

“This prognostic model can effectively predict 1-year risk of [Crohn’s disease-related] intestinal surgery, which will assist in screening progressive [Crohn’s disease] patients and tailoring therapeutic management,” the authors wrote.

Accelerated therapeutic treatment could be beneficial for patients with progressive Crohn’s disease to prevent complications and surgery, suggesting that screening for risk factors and predicting the need for early surgery could be of clinical importance.

Recently, investigators identified the allele HLA-DQA1*05 as a useful biomarker in predicting anti-drug antibodies for Crohn’s disease patients.

A team, led by Alekseis Sazonovs, Wellcome Sanger Institute, performed a genome-wide association study to identify variants linked to the time of development of anti-drug antibodies of 1240 biologic-naïve patients with Crohn’s disease starting anti-tumor necrosis factor (anti-TNF) drugs such as infliximab or adalimumab.

In the multicenter, prospective observation cohort, investigators identified the treatment failure rates of infliximab, the biosimilar CT-P13, and adalimumab. Patients were initially studied for 12 months or until drug withdrawal.

In the first year, study visits were scheduled at first dose, post-induction weeks 12-14, weeks 30 and 54, and at treatment failure.

The HLA-DQA1*05 allele, which significantly increases the rate of immunogenicity (HR, 1.90; 95% CI, 1.60—2.25; P = 5.88 × 1013), is carried by approximately 40% of Europeans.

“The highest rates of immunogenicity, 92% at 1 year, were observed in patients treated with infliximab monotherapy who carried HLA-DQA1*05,” the authors wrote. “Conversely the lowest rates of immunogenicity, 10% at 1 year, were observed in patients treated with adalimumab combination therapy who did not carry HLA-DQA1*05.”

In the replication cohort, the investigators confirmed the findings of the previous study (HR, 2.00; 95% CI, 1.35—2.98; P = 6.60 × 10-4).

The association was consistent for patients treated with adalimumab (HR, 1.89; 95% CI, 1.32—2.70) or infliximab (HR, 1.92; 95% CI, 1.57–2.33), as well as for patients treated with anti-TNF therapy alone (HR, 1.75; 95% CI, 1.37–2.22) or in combination with an immunomodulatory (HR, 2.01; 95% CI, 1.57–2.58).

The study, “Development of a prognostic model for one-year surgery risk in Crohn’s disease patients: A retrospective study,” was published online in the World Journal of Gastroenterology.