SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Philippe SEKSIK
Coup de coeur :
 
 
Alimentary Pharmacology & Therapeutics (APT)
  2016/01  
 
  2016 Jan;43(2):262-71  
  doi: 10.1111/apt.13460. Epub 2015 Nov 15.  
 
  A validated web-based tool to display individualised Crohn's disease predicted outcomes based on clinical, serologic and genetic variables.  
 
  Siegel CA, Horton H, Siegel LS, Thompson KD, Mackenzie T, Stewart SK, Rice PW, Stempak JM, Dezfoli S, Haritunians T, Levy A, Baek M, Milgrom R, Dulai PS, Targan SR, Silverberg MS, Dubinsky MC, McGovern DP  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=A+validated+web-based+tool+to+display+individualised+Crohn%27s+disease+predicted+outcomes+based+on+clinical%2C+serologic+and+genetic+variables.  
 
 

BACKGROUND: Early treatment for Crohn's disease (CD) with immunomodulators and/or anti-TNF agents improves outcomes in comparison to a slower 'step up' algorithm. However, there remains a limited ability to identify those who would benefit most from early intensive therapy.

AIM: To develop a validated, individualised, web-based tool for patients and clinicians to visualise individualised risks for developing Crohn's disease complications.

METHODS: A well-characterised cohort of adult patients with CD was analysed. Available data included: demographics; clinical characteristics; serologic immune responses; NOD2 status; time from diagnosis to complication; and medication exposure. Cox proportional analyses were performed to model the probability of developing a CD complication over time. The Cox model was validated externally in two independent CD cohorts. Using system dynamics analysis (SDA), these results were transformed into a simple graphical web-based display to show patients their individualised probability of developing a complication over a 3-year period.

RESULTS: Two hundered and forty three CD patients were included in the final model of which 142 experienced a complication. Significant variables in the multivariate Cox model included small bowel disease (HR 2.12, CI 1.05-4.29), left colonic disease (HR 0.73, CI 0.49-1.09), perianal disease (HR 4.12, CI 1.01-16.88), ASCA (HR 1.35, CI 1.16-1.58), Cbir (HR 1.29, CI 1.07-1.55), ANCA (HR 0.77, CI 0.62-0.95), and the NOD2 frameshift mutation/SNP13 (HR 2.13, CI 1.33-3.40). The Harrell's C (concordance index for predictive accuracy of the model) = 0.73. When applied to the two external validation cohorts (adult n = 109, pediatric n = 392), the concordance index was 0.73 and 0.75, respectively, for adult and pediatric patients.

CONCLUSIONS: A validated, web-based tool has been developed to display an individualised predicted outcome for adult patients with Crohn's disease based on clinical, serologic and genetic variables. This tool can be used to help providers and patients make personalised decisions about treatment options.

 
Question posée
 
A l’heure de la médecine personnalisée, pouvons-nous mixer des éléments cliniques et biologiques pour prédire le risque évolutif chez les patients atteints de maladie de Crohn ?
 
Question posée
 
Peut-être, en utilisant des biomarqueurs tels que des anti-corps anti-micro-organismes (ANCA, ASCA CBir1), le génotypage NOD2 et des données cliniques chez des patients adultes entrant dans la maladie.
 
Commentaires

Une étude tendant à valider un kit sérologique, génétique et un serveur utilisable sur le web. L’étude génétique se limite essentiellement à l’étude de NOD2 et les ‘sérologies’ sont faite une seule fois. Les courbes de survie ne sont pas fournies car l’outil n’est développé qu’à l’échelle individuelle, les auteurs expliquant qu’ils ne peuvent pas comparer les résultats entre eux. De plus, cette étude a été réalisées à partir de malades de centres tertiaires et ne s’adresse qu’à des patients non compliqués (typiquement B1) débutant leur maladie de Crohn. Clairement, la généralisation de ce type d’outils n’est pas faite.

 
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