Crohn’s disease and ulcerative colitis patient-reported outcomes signs and symptoms for the remote management of inflammatory bowel disease during the COVID-19 pandemic

Abstract

Background and aims The COVID-19 pandemic has led to a deep reorganization of hospital services including inflammatory bowel disease (IBD) units. In this situation, conversion of in-person routine follow-up visits into phone consultations might be necessary. Here we explored the feasibility of using the validated Crohn’s Disease (CD) or Ulcerative Colitis (UC) Patient-Reported Outcomes Signs and Symptoms (CD- and UC-PRO/SS) to collect data about abdominal symptoms (abdominal/S) and bowel signs and symptoms (bowel/SS) remotely. Methods CD- and UC-PRO/SS were collected during phone consultations and compared among patients with active and inactive disease. The effectiveness of therapeutic intervention in patients with active disease was assessed by PRO/SS variation. Results Twenty-one CD and 56 UC patients were evaluated by phone. Six (28.6%) CD and 15 (26.8%) UC patients were considered to have active disease. In CD the bowel/SS but not the abdominal/S module was significantly higher in active patients (mean bowel/SS 2.50 [SE ± 0.44] active vs 0.76 [SE ± 0.18] remission, p = 0.008, AUC 0.87; mean abdominal/S 1.11 [SE ± 0.38] active vs 0.24 [SE ± 0.13] remission, p = 0.066). UC-PRO/SS measures were significantly higher in active patients as compared to patients in remission (median bowel/SS 1.63 [SE ± 0.24] active vs 0.33 [SE ± 0.04] remission; p < 0.0001, AUC 0.91; mean abdominal/S 1.03 [SE ± 0.24] vs 0.37 [SE ± 0.12]; p = 0.009, AUC 0.71). Therapy was escalated in 12 patients (3 CD and 9 UC) due to disease relapse. Therapy escalation resulted in the reduction of PRO/SS as evaluated at the subsequent phone consultation. Conclusions PRO/SS might represent a feasible tool to evaluate disease activity and therapy outcome in IBD patients during periods of limited access to outpatient clinics.

Efficacy of vedolizumab during intravenous induction therapy in ulcerative colitis and Crohn’s disease: post hoc analysis of patient-reported outcomes from the VISIBLE 1 and 2 studies

“…STRIDE II guidelines also note the strong correlation between PROs and patient wellbeing in IBD, emphasizing the importance of early and frequent PRO assessment to monitor disease activity, with symptom relief considered to be the earliest treatment target [ 8 ]. Although there are currently no validated PRO tools for UC and CD [ 6 , 34 ], symptom-based PRO measures adapted from the Mayo score and CDAI are considered useful [ 8 ], especially for remote patient management settings necessitated during the COVID-19 pandemic owing to the suspension of in-person patient visits [ 35 ]. There is also evidence of PROs being responsive to treatment effects and showing correlations with some clinical and endoscopic endpoints [ 5 , 6 , 34 ].…”

Telemedicine in inflammatory bowel diseases: A new brick in the medicine of the future?

“…Pinto et al [ 62 ] telemonitored 21 patients with CD and 56 patients with UC via telephone calls during the COVID-19 pandemic through a collection of patient-reported outcomes to assess disease activity and adopt treatment adjustments.…”

Increased Self-medication with Steroids in Inflammatory Bowel Disease Patients during COVID-19 Pandemic: Time to Optimize Specialized Telemonitoring Services

“…Telemedicine services are a popular approach that has shown promising results in IBD care, especially in times of the COVID-19 pandemic. 13 , 14 Although telemedicine services may not be equivalent to that of standard referral center care, it is a cost-effective platform that can avoid unnecessary health center visits, particularly with the current travel restrictions. 15 Telemonitoring interventions from IBD healthcare providers in the form of weekly assessment of symptoms, medication reconciliation, side effect profile monitoring, and specified action plans help monitor patients with active IBD symptoms.…”