PCDAI -Not Good Enough

Two articles reinforce the view that the pediatric Crohn’s Disease activity index (PCDAI) is not good enough to rely on for research and for clinical practice.

  • Sun H et al. JPGN 2015; 60: 729-36
  • Vubin G, Peter L. Inflamm Bowel Dis 2015; 21: 1386-91

The first article is a review of the PCDAI and its derivatives (abbreviated, short, modified, and weighted) as well as the Harvey-Bradshaw Index (HBI). Key points:

  • There was an “absence of evidence demonstrating correlation with clinically relevant inflammation.”
  • “Available evidence indicates that CDAI, HBI, and 5 versions of PCDAI lack adequate measurement properties for use as a primary endpoint for phase 3 trials.”
  • “Endoscopic or radiology-based mucosal and histological examination may need to be considered as 1 outcome measurement.”

The second article describes a prospective cohort of 24 newly diagnosed children (<16 years).  The authors found the following:

  • At diagnosis, PCDAI had poor correlation with endoscopic disease activity (SES-CD)
  • After induction: 11/24 had inactive disease based on SES-CD; however, PCDAI had poor correlation.  Many children with active disease (SES-CD ≥3) had normalization of PCDAI as well as CRP.
  • Fecal calprotectin had better correlation.

Take-home point: These articles add to the growing literature regarding the lack of reliability of clinical activity indices.

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