P1152 Single center study of using clinical decision support tool to predict outcomes of vedolizumab therapy in Crohn’s disease patients
Authors: Konecny S , Tichanek F , Prokopova L , Kavrikova P , Zvarova V , Poredska K , Zboril V 
Published: January 2025

Background

There is a need to identify Crohn’s Disease (CD) patients who will be most suitable and obtain most clinical benefit from treatment with vedolizumab (VDZ), an anti-α4β7 integrin inhibitor for the treatment of ulcerative colitis and Crohn’s Disease (CD). Previously, a clinical decision support tool (CDST) has been developed and validated to guide treatment decisions in CD patients treated with VDZ.1 In this study, we analyzed the ability of the CDST to predict clinical outcomes in CD patients.

Methods

Patients with moderate to severe CD receiving maintenance treatment with VDZ in single center were retrospectively analyzed using the CDST. We divided patient by CDST into low (≤13 points), intermediate (&gt;13 and ≤19 points) and high response probability groups (&gt;19 points) based on the previously developed scoring system. Clinical outcomes assessed included persistence on therapy and CD-related hospitalizations and surgery rates.

Results

We included 174 patients who were treated with VDZ for at least 6 months in our center. Using the CDST, at baseline, 23 patients (13%) had a low, 81 (47%) had an intermediate, and 70 (40%) had a high probability of treatment response with VDZ.

Patients with low probability showed a trend toward reduced persistence on therapy, though this difference did not reach statistical significance (p=0.13). However, when patients were analyzed according to disease location by Montreal classification, a clearer pattern emerged in those with isolated ileal (L1) or colonic (L2) CD. In this subgroup, patients with high probability of treatment response to VDZ demonstrated significantly longer treatment persistence (p=0.038); 91% of these patients remained on therapy after two years compared to 55% in the intermediate group. This trend was not observed in ileocolonic (L3) CD, where persistence rates were similar across groups (83% in high and intermediate groups and 75% in the low probability group; p=0.23).

We tried to assess the ability of CDST in prediction of complications of CD and we observed that number of hospitalization days was significantly lower in the high probability group (median: 0; third quartile: 4 days) compared to the intermediate group (median: 17; third quartiles: 9 and 21 days; p&lt;0.001), while surgery rates showed no significant differences across groups (p=0.5).

Conclusion

The CDST partially identifies CD patients likely to benefit from VDZ. Patients with low CDST scores demonstrate poorer persistence, particularly in the subgroup with L1/L2 localization, and a higher risk of hospitalization, while those with high CDST scores exhibit better treatment persistence. These findings further validate the CDST as a valuable tool for guiding treatment decisions in CD.

References

1.Dulai PS, Boland BS, Singh S, et al. Development and Validation of a Scoring System to Predict Outcomes of Vedolizumab Treatment in Patients With Crohn's Disease. Gastroenterology. 2018;155(3):687-695.e10.