Dulai et al reported a clinical decision support tool (CDST) for the use of vedolizumab in a patient with Crohn's disease. This can help to identify if a patient is likely to benefit from its use. The authors are from multiple institutions in the United States, France, Switzerland and Canada.
Patient selection: ulcerative colitis
Parameters:
(1) history of bowel surgery
(2) history of prior TNF-alpha antagonist therapy
(3) history of fistulising disease
(4) baseline serum albumin in g/L
(5) baseline serum C-reactive protein (CRP) in mg/L
Parameter
Finding
Points
history of bowel surgery
no
2
yes
0
history of prior TNF-alpha antagonist therapy
no
3
yes
0
history of fistula
no
2
yes
0
serum albumin
0.4 * (albumin)
serum CRP
< 3 mg/L
0
3 to 10 mg/L
-0.5
> 10 mg/L
-3
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: around: 1 (dependent on serum albumin)
• maximum score: around 31 (dependent on serum albumin)
• The higher the score the better the remission rate and longer the time to surgery after vedolizumab is started.
Total Score
Probability of Response
<= 13
low
13.01 to 19
intermediate
> 19
high
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