AGA risk assessment tool aids patient, physician decision-making for Crohn’s therapy
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DENVER — A risk stratification assessment assisted both patients with Crohn’s disease and their physicians when making decisions about treatment, according to data presented at the Crohn’s and Colitis Congress.
Earlier introduction of advanced therapy may improve longer-term clinical outcomes in CD, with current clinical guidelines recommending the incorporation of risk stratification assessment for disease severity and activity, Ryan C. Ungaro, MD, MS, associate professor medicine at the Icahn School of Medicine at Mount Sinai, told attendees. These assessments may also assist in shared physician and patient decision-making.
In a multicenter, prospective study, Ungaro and colleagues evaluated the impact of the AGA Crohn’s Disease Care Pathway risk assessment tool on the decision to begin or change therapy among gastroenterologists and their bionaive patients with CD. Using this tool, patients with any risk factors for rapid disease progression (aged < 30 years at diagnosis, deep ulcers, extensive anatomic involvement, perianal disease, prior CD surgery and/or stricturing or penetrating behavior) were deemed moderate to high risk.
Forty-seven patient/physician pairs across 14 sites received their risk assessment report and were surveyed at baseline and 7 days after assessment review. The mean age of patients with CD was 40.2 years, 59% were men, 70% were white, 80% had inflammatory disease behavior, 74% has no prior CD-related hospitalizations and 82% had no prior CD-related surgeries.
The primary outcome of interest was behavioral change, defined as any treatment modification or increased physician or patient self-assessed confidence in the need for treatment change.
According to AGA criteria, 64% of patients were moderate to high risk, although only 40% of patients self-assessed their risk as moderate to high, and 36% were low risk. The most common moderate to high risk factors were age (younger than 30 years, 45%) and stricturing or penetrating disease behavior (20%). Nearly half (49%) of physician risk assessments conflicted with AGA risk stratification at baseline.
At day 7, researchers reported behavioral change among 52% of participants regardless of risk stratification, with patient confidence increasing among 21% and physician confidence increasing in 23%. Treatment recommendation changed in 36% of cases.
Confidence that patients would benefit from treatment change decreased among both physicians (47%) and patients (59%) assessed as low risk.
“Crohn’s patients tended to underestimate the risk of disease progression, and GI’s assessment of patient risk was frequently discordant with the AGA care pathway,” Ungaro said. “Reviewing a risk stratification did result in behavioral change.”
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Ungaro RC, et al. Presentation 14: Incorporation of risk assessment tool impacts patient and gastroenterologist confidence and treatment decision making in bionaive Crohn’s disease. Presented at: Crohn’s and Colitis Congress; Jan. 12-22, 2023; Denver (hybrid meeting).
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