Abstract
PURPOSE: The prediction of the loss of response (LOR) to infliximab (IFX) is crucial for optimizing treatment strategies and shifting biologics. However, a secondary LOR is difficult to predict by endoscopy due to the intestinal stricture, perforation, and fistulas. This study aimed to develop and validate a radiomic nomogram for the prediction of secondary LOR to IFX in patients with Crohn's disease (CD). PATIENTS AND METHODS: A total of 186 biologic-naive patients diagnosed with CD between September 2016 and June 2019 were enrolled. Secondary LOR was determined during week 54. Computed tomography enterography (CTE) texture analysis (TA) features were extracted from lesions and analyzed using LIFEx software. Feature selection was performed by least absolute shrinkage and selection operator (LASSO) and ten-fold cross validation. A nomogram was constructed using multivariable logistic regression, and the internal validation was approached by ten-fold cross validation. RESULTS: Predictors contained in the radiomics nomogram included three first-order and five second-order signatures. The prediction model presented significant discrimination (AUC, 0.880; 95% CI, 0.816-0.944) and high calibration (mean absolute error of = 0.028). Decision curve analysis (DCA) indicated that the nomogram provided clinical net benefit. Ten-fold cross validation assessed the stability of the nomogram with an AUC of 0.817 and an accuracy of 0.819. CONCLUSION: This novel radiomics nomogram provides a predictive tool to assess secondary LOR to IFX in patients with Crohn's disease. This tool will help physicians decide when to switch therapy.