In the Journals

User-friendly tool helps identify colectomy risk in patients with UC

A user-friendly tool, designed by researchers to help guide therapy choices for patients with ulcerative colitis, helped physicians identify patients at higher risk for total proctocolectomy, according to study results published in Inflammatory Bowel Diseases.

Gary Lichtenstein, MD, of the Perelman Center for Advanced Medicine, and colleagues wrote that UC can vary patient to patient. Although some improve with medical therapy, those who fail to respond go on to need surgery, which can impact quality of life.

“Few data exist to guide therapy, and it remains a challenge to appropriately risk-stratify individuals in whom to escalate medical therapy to minimize future disease complications such as total proctocolectomy [TPC],” they wrote. “This is especially important, as unnecessary immunosuppressive therapy in lower-risk individuals is costly and has the potential to increase the risk for adverse effects.”

Researchers set out to develop a tool that could help predict future TPC risk in patients with UC. They reviewed clinic charts and identified cases, defined as patients who underwent TPC for refractory UC (n = 115), and matched them to patients with no prior UC-related surgery (n = 325). They built the tool with data from two-thirds of the patients and used the final third as a validation group.

Investigators determined that albumin, a 9-point Mayo score greater than 5, Mayo endoscopic subscore greater than 1, and corticosteroid use within 6 months were all predictors of TPC. The areas under the receiver operating characteristic curve for the multivariable model were 0.94 (95% CI, 0.92–0.95) for the test cohort, and 0.92 (95% CI, 0.89–0.95) for the validation cohorts.

Lichtenstein and colleagues wrote that the validation cohort demonstrated a significant difference in calculated probability distributions between patients who had surgery and patients who did not (P < .01). Researchers built their tool into an online application to allow for easy access.

The researchers wrote that external studies are needed to validate their tool but believe it could be helpful in stratifying patients.

“Even high-risk patients are sometimes reluctant to escalate medical therapy at the recommendations of their provider,” they wrote. “The patient-provider relationship thrives on adequate informed consent, and a tool that quantifies a patient’s surgical risk in UC can empower patients to contribute to their care plan.” – by Alex Young

Disclosures: Lichtenstein reports that he has received research/grant support and support for lectures and scientific advisory committee participation from Abbott, Actavis, Alaven, CellCeutrix, Celgene, Clinical Advances in Gastroenterology, Ferring, Gastro-Hep Communications, Gilead, Hospira, Ironwood, Janssen Orthobiotech, Luitpold/American Regent, Merck, McMahon Publishing, Pfizer Pharmaceuticals, Prometheus Laboratories Inc., Romark, Salix Pharmaceuticals, Santarus, Shire Pharmaceuticals, Slack Inc., Springer Science and Business Media, Takeda, UCB, and Up-To-Date. Please see the full study for all other authors’ relevant financial disclosures.

A user-friendly tool, designed by researchers to help guide therapy choices for patients with ulcerative colitis, helped physicians identify patients at higher risk for total proctocolectomy, according to study results published in Inflammatory Bowel Diseases.

Gary Lichtenstein, MD, of the Perelman Center for Advanced Medicine, and colleagues wrote that UC can vary patient to patient. Although some improve with medical therapy, those who fail to respond go on to need surgery, which can impact quality of life.

“Few data exist to guide therapy, and it remains a challenge to appropriately risk-stratify individuals in whom to escalate medical therapy to minimize future disease complications such as total proctocolectomy [TPC],” they wrote. “This is especially important, as unnecessary immunosuppressive therapy in lower-risk individuals is costly and has the potential to increase the risk for adverse effects.”

Researchers set out to develop a tool that could help predict future TPC risk in patients with UC. They reviewed clinic charts and identified cases, defined as patients who underwent TPC for refractory UC (n = 115), and matched them to patients with no prior UC-related surgery (n = 325). They built the tool with data from two-thirds of the patients and used the final third as a validation group.

Investigators determined that albumin, a 9-point Mayo score greater than 5, Mayo endoscopic subscore greater than 1, and corticosteroid use within 6 months were all predictors of TPC. The areas under the receiver operating characteristic curve for the multivariable model were 0.94 (95% CI, 0.92–0.95) for the test cohort, and 0.92 (95% CI, 0.89–0.95) for the validation cohorts.

Lichtenstein and colleagues wrote that the validation cohort demonstrated a significant difference in calculated probability distributions between patients who had surgery and patients who did not (P < .01). Researchers built their tool into an online application to allow for easy access.

The researchers wrote that external studies are needed to validate their tool but believe it could be helpful in stratifying patients.

“Even high-risk patients are sometimes reluctant to escalate medical therapy at the recommendations of their provider,” they wrote. “The patient-provider relationship thrives on adequate informed consent, and a tool that quantifies a patient’s surgical risk in UC can empower patients to contribute to their care plan.” – by Alex Young

Disclosures: Lichtenstein reports that he has received research/grant support and support for lectures and scientific advisory committee participation from Abbott, Actavis, Alaven, CellCeutrix, Celgene, Clinical Advances in Gastroenterology, Ferring, Gastro-Hep Communications, Gilead, Hospira, Ironwood, Janssen Orthobiotech, Luitpold/American Regent, Merck, McMahon Publishing, Pfizer Pharmaceuticals, Prometheus Laboratories Inc., Romark, Salix Pharmaceuticals, Santarus, Shire Pharmaceuticals, Slack Inc., Springer Science and Business Media, Takeda, UCB, and Up-To-Date. Please see the full study for all other authors’ relevant financial disclosures.

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