Inflammatory bowel disease (IBD) effects an estimated 3 million patients in the United States. Patients with IBD have a highly variable disease course, so it is important to identify patients at high risk of complications early, when there is still an opportunity to intervene and avoid irreversible damage. Over the past couple of years, several clinical decision support tools (CDSTs) have emerged to more effectively risk stratify patients and one actually predicts their response to certain biologics before they even start them.
CDPATH uses serologic and genetic testing, disease phenotype, and demographic information to predict a patient’s individualized risk for developing serious complications related to Crohn’s within 3 years. These complications are defined as the development of fistulas, strictures, or CD-related surgery anywhere in the bowels other than in or around the anus. The tool outputs a graphical presentation of each patient’s risk over a three-year period, making it an excellent visual for shared-decision making conversations. CDPATH is only for adult patients with CD with or without insurance who have not yet experienced a serious complication from CD. A blood draw is required at a participating location. Although CDPATH is a commercial product, the test (but not necessarily the phlebotomy service) is free of charge for eligible patients. CDPATH can be accessed here: https://www.cdpath.com/hcp
The AGA Care Pathways is a CDST for both UC and CD. While it does not output individualized risk predictions, it provides users with risk factors for colectomy (UC) or disease progression (CD); guideline-based recommendations for initial therapy; clinical, biomarker, and endoscopic targets for remission; treatment optimization strategies for patients failing to achieve remission; a listing of FDA approved therapies in UC vs. CD; tips on implementing shared-decision making in clinical practice; and practical advice on navigating the prior authorization process, including appeals. While the tool is not patient specific, it is extremely user friendly and succinctly presents providers with a wealth of information to guide decision making. The tool additionally has a patient/caregiver-facing component. The AGA Care Pathways is a free online tool and can be accessed here: https://ibd.care/provider/aga-care-pathways/aga-care-pathways-introduction
Through a series of binary questions related to the patient’s history and clinical workup, the IBD CDST can risk stratify patients with CD and UC into “high” and “low” categories. For patients deemed at high risk of disease progression (CD) or colectomy (UC), users can progress to the predictive model portion of the tool. In this portion, providers answer a second series of binary questions related to a patient’s history and clinical work up and provide CRP and albumin concentrations. The tool then outputs the patient’s individualized probability of reaching clinical remission for each biologic listed in the tool, as well as how quickly they should expect to see a response from the biologic, and if more frequent follow ups or drug concentration monitoring should be considered.
This CDST is a free, globally available online tool and can be accessed here: CDSTforIBD.com
For more on these tools, including cases studies demonstrating each, check out Getting it Right in Ulcerative Colitis: A Clinical Guideline and Decision Tool-Based Approach (part 1 of 2) – RMEI and Getting it Right in Crohn’s Disease: A Clinical Guideline and Decision Tool-Based Approach (part 2 of 2) – RMEI.
For more on these tools, including cases studies demonstrating each, check out Getting it Right in Ulcerative Colitis: A Clinical Guideline and Decision Tool-Based Approach (part 1 of 2) – RMEI and Getting it Right in Crohn’s Disease: A Clinical Guideline and Decision Tool-Based Approach (part 2 of 2) – RMEI
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