User Story: Treating IBD with Biologics
Ordering Provider
John Gubatan, MD, Clinical Faculty, Gastroenterology & Hepatology, Chan Zuckerberg Biohub Physician-Scientist Scholar, and Doris Duke Physician-Scientist Fellow
How did you hear about the informatics consult program?
I attended the GI grand rounds presentation that [Atropos Chief Medical Officer] Saurabh gave a few months ago and I had heard from other colleagues that the service was great.
What is your primary area of interest?
I specialize in translational clinical research, ranging from my work in a wet lab where I study single-cell genomics, blood stool biopsies, and T-cell / B-cell responses all the way through building machine learning models to correlate clinical findings with different immune responses and gene expression.
What question did you ask the Atropos informatics consult service?
What is the association between the use of anti-TNF biologics (infliximab, adalimumab, cetrolizumab, golimumab) in patients with IBD and risk of extraintestinal manifestations of IBD: 1) skin 2) joints 3) eye 4) hepatobiliary?
What is the risk of colonic neoplasia (e.g., colon cancer and adenomatous polyps) in patients treated with anti-TNF biologics (infliximab, adalimumab, certolizumab, golimumab) for IBD?
What would you have used to answer this type of question in the past (before the informatics consult service was available)?
We’ve previously done studies like this using Stanford’s local STARR database. It can take weeks just to get all the data downloaded and validated from all the different tables (e.g., drugs, diagnoses, procedures, labs). We also have residents and med students that do various forms of manual chart reviews that can take months to complete.
Then once we have all the data, we usually use STATA for the analytics which can take weeks to months depending on the complexity of the analysis and the familiarity we have with the data.
In your own words, please describe the Atropos informatics consult service
The Atropos informatics consult service is going to transform our ability to test clinical hypotheses. It’s not just fast, but it’s methodologically rigorous using the latest propensity matching models. It allows us to get at the heart of research questions without having to wait months.
At Stanford we have a consulting biostatistics team that can help with our research, but they are so underresourced, it usually takes at least 2 weeks to hear back just on the study’s feasibility. During the height of the COVID pandemic, I had submitted request to that team and didn’t get a response back until after my paper was already accepted for publication. With Atropos, we got usable answers in a matter of days.
Any concluding thoughts?
Just to reframe how helpful this service is for clinicians like me, it likely would have taken 2 people roughly 12 months to complete this analysis. Instead, I spent a total of an hour or two, including asking the question and digesting the results. I now have a podium talk at DDW in May to present our findings!
I have already recommended the service to others and I have a lot more questions to pursue in the coming months. There are many interesting investigations to do in understudied downstream effects of biologics on the treatment of IBD and I’m looking forward to continuing to dig in this area and more with Atropos!
John Gubatan, MD, Clinical Faculty, Gastroenterology & Hepatology, at Stanford University
