Research Article | | Peer-Reviewed

Predictive Model for Nonadherence to Biologic Therapy in Ulcerative Colitis Patients Based on Machine Learning

Received: 17 April 2025     Accepted: 27 April 2025     Published: 22 May 2025
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Abstract

Objective: To develop a clinical prediction model for nonadherence to biologic therapy in patients with ulcerative colitis (UC) using machine learning techniques, and to assess its predictive accuracy to guide clinical interventions. Methods: A total of 221 UC patients who initiated biologic therapy between December 2023 and February 2025 at our hospital were included in this study. Data on 15 variables, such as age, sex, disease duration, and other clinical factors, were collected. Medication adherence was measured using the proportion of days covered (PDC), with a PDC >80% considered indicative of good adherence. The Support Vector Machine (SVM) and Boruta algorithms were employed to identify key predictors. A multivariate logistic regression model was developed using the intersection of factors identified by both algorithms. Model performance was evaluated using the C-index, ROC curve, calibration curve, decision curve analysis, and validation with the K-nearest neighbor (KNN) algorithm. Results: Of the 221 patients, 82 (37.1%) were categorized into the nonadherence group. Following factor selection, insurance status, depression level, education level, disease activity, and age were identified as significant predictors of nonadherence. The model demonstrated a C-index of 0.779, and the ROC curve showed an area under the curve (AUC) of 0.78. Calibration curve analysis revealed good model consistency, and KNN validation yielded high precision with an AUC of 0.9978 and a PR AUC of 0.9963. Conclusion: The developed prediction model for medication nonadherence in UC patients demonstrates robust predictive and calibration capabilities. This model may aid healthcare professionals in identifying high-risk patients and supporting timely clinical interventions.

Published in American Journal of Nursing Science (Volume 14, Issue 2)
DOI 10.11648/j.ajns.20251402.12
Page(s) 30-36
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Ulcerative Colitis, Machine Learning, Clinical Prediction Model, Boruta, SVM-REF

References
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[2] Asakura K, Nishiwaki Y, Inoue N, et al. Prevalence of ulcerative colitis and Crohn’s disease in Japan. J Gastroenterol 2009; 44: 659-665.
[3] Fumery M, Singh S, Dulai PS, et al. Natural history of adult ulcerative colitis in population-based cohorts: a systematic review. Clin Gastroenterol Hepatol. 2018; 16(343–356): e343.
[4] Jackson CA, Clatworthy J, Robinson A, et al. Factors associated with non-adherence to oral medication for inflammatory bowel disease: a systematic review. Am J Gastroenterol 2010, 105(3): 525–539.
[5] Vangeli E, Bakhshi S, Baker A et al. A systematic review of factors associated with non-adherence to treatment for immune-mediated inflammatory diseases. Adv Ther. 2015; 32(11): 983–1028.
[6] Maaser C, Sturm A, Vavricka SR, et al. ECCO-ESGAR guideline for diagnostic assessment in IBD part 1:initial diagnosis, monitoring of known IBD, detection of complications J. J Crohns Colitis, 2019, 13(2): 144-164.
[7] Dong Enhong, Bao Yong. Reliability and Validity of the Chinese Revised Version of the Wake Forest Physician Trust Scale. Chinese Journal of Mental Health, 2012, 26(3): 171-175.
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[11] Choudhry NK, Shrank WH, Levin RL, et al. Measuring concurrent adherence to multiple related medications. Am J Manag Care. 2009, 15(7): 457-464.
[12] Yuan H, Ali M S, Brouwer E S, et al. Real‐World Evidence: What It Is and What It Can Tell Us According to the International Society for Pharmacoepidemiology (ISPE) Comparative Effectiveness Research (CER) Special Interest Group (SIG) [J]. Clinical Pharmacology & Therapeutics, 2018, 14(2).
[13] Xu F, Tang J, Zhu Z, et al. Medication Adherence and Its Influencing Factors Among Inflammatory Bowel Disease Patients in China. Int J Gen Med. 2022; 15: 4141-4149.
[14] D'Incà R, Bertomoro P, Mazzocco K, et al. Risk factors for non-adherence to medication in inflammatory bowel disease patients. Aliment Pharmacol Ther. 2008; 27(2): 166-172.
[15] Ediger JP, Walker JR, Graff L, et al. Predictors of medication adherence in inflammatory bowel disease. AmJ Gastroenterol 2007; 102: 1417-1426.
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[17] Robinson A, Hankins M, Wiseman G, et al. Maintaining stable symptom control in inflammatory bowel disease: a retrospective analysis of adherence, medication switches and the risk of relapse. Aliment Pharmacol Ther. 2013; 38: 531–538.
[18] Moody GA, Jayanthi V, Probert CS, et al. Long-term therapy with sulphasalazine protects against colorectal cancer in ulcerative colitis: a retrospective study of colorectal cancer risk and compliance with treatment in Leicestershire. Eur J Gastroenterol Hepatol. 1996; 8(12): 1179–1183.
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Cite This Article
  • APA Style

    Huang, X., Zhang, Y., Wang, Y., Lin, H., Yang, Y. (2025). Predictive Model for Nonadherence to Biologic Therapy in Ulcerative Colitis Patients Based on Machine Learning. American Journal of Nursing Science, 14(2), 30-36. https://doi.org/10.11648/j.ajns.20251402.12

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    ACS Style

    Huang, X.; Zhang, Y.; Wang, Y.; Lin, H.; Yang, Y. Predictive Model for Nonadherence to Biologic Therapy in Ulcerative Colitis Patients Based on Machine Learning. Am. J. Nurs. Sci. 2025, 14(2), 30-36. doi: 10.11648/j.ajns.20251402.12

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    AMA Style

    Huang X, Zhang Y, Wang Y, Lin H, Yang Y. Predictive Model for Nonadherence to Biologic Therapy in Ulcerative Colitis Patients Based on Machine Learning. Am J Nurs Sci. 2025;14(2):30-36. doi: 10.11648/j.ajns.20251402.12

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  • @article{10.11648/j.ajns.20251402.12,
      author = {Xian Huang and Yan Zhang and Yanru Wang and Huamei Lin and Yuzhu Yang},
      title = {Predictive Model for Nonadherence to Biologic Therapy in Ulcerative Colitis Patients Based on Machine Learning
    },
      journal = {American Journal of Nursing Science},
      volume = {14},
      number = {2},
      pages = {30-36},
      doi = {10.11648/j.ajns.20251402.12},
      url = {https://doi.org/10.11648/j.ajns.20251402.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20251402.12},
      abstract = {Objective: To develop a clinical prediction model for nonadherence to biologic therapy in patients with ulcerative colitis (UC) using machine learning techniques, and to assess its predictive accuracy to guide clinical interventions. Methods: A total of 221 UC patients who initiated biologic therapy between December 2023 and February 2025 at our hospital were included in this study. Data on 15 variables, such as age, sex, disease duration, and other clinical factors, were collected. Medication adherence was measured using the proportion of days covered (PDC), with a PDC >80% considered indicative of good adherence. The Support Vector Machine (SVM) and Boruta algorithms were employed to identify key predictors. A multivariate logistic regression model was developed using the intersection of factors identified by both algorithms. Model performance was evaluated using the C-index, ROC curve, calibration curve, decision curve analysis, and validation with the K-nearest neighbor (KNN) algorithm. Results: Of the 221 patients, 82 (37.1%) were categorized into the nonadherence group. Following factor selection, insurance status, depression level, education level, disease activity, and age were identified as significant predictors of nonadherence. The model demonstrated a C-index of 0.779, and the ROC curve showed an area under the curve (AUC) of 0.78. Calibration curve analysis revealed good model consistency, and KNN validation yielded high precision with an AUC of 0.9978 and a PR AUC of 0.9963. Conclusion: The developed prediction model for medication nonadherence in UC patients demonstrates robust predictive and calibration capabilities. This model may aid healthcare professionals in identifying high-risk patients and supporting timely clinical interventions.
    },
     year = {2025}
    }
    

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  • TY  - JOUR
    T1  - Predictive Model for Nonadherence to Biologic Therapy in Ulcerative Colitis Patients Based on Machine Learning
    
    AU  - Xian Huang
    AU  - Yan Zhang
    AU  - Yanru Wang
    AU  - Huamei Lin
    AU  - Yuzhu Yang
    Y1  - 2025/05/22
    PY  - 2025
    N1  - https://doi.org/10.11648/j.ajns.20251402.12
    DO  - 10.11648/j.ajns.20251402.12
    T2  - American Journal of Nursing Science
    JF  - American Journal of Nursing Science
    JO  - American Journal of Nursing Science
    SP  - 30
    EP  - 36
    PB  - Science Publishing Group
    SN  - 2328-5753
    UR  - https://doi.org/10.11648/j.ajns.20251402.12
    AB  - Objective: To develop a clinical prediction model for nonadherence to biologic therapy in patients with ulcerative colitis (UC) using machine learning techniques, and to assess its predictive accuracy to guide clinical interventions. Methods: A total of 221 UC patients who initiated biologic therapy between December 2023 and February 2025 at our hospital were included in this study. Data on 15 variables, such as age, sex, disease duration, and other clinical factors, were collected. Medication adherence was measured using the proportion of days covered (PDC), with a PDC >80% considered indicative of good adherence. The Support Vector Machine (SVM) and Boruta algorithms were employed to identify key predictors. A multivariate logistic regression model was developed using the intersection of factors identified by both algorithms. Model performance was evaluated using the C-index, ROC curve, calibration curve, decision curve analysis, and validation with the K-nearest neighbor (KNN) algorithm. Results: Of the 221 patients, 82 (37.1%) were categorized into the nonadherence group. Following factor selection, insurance status, depression level, education level, disease activity, and age were identified as significant predictors of nonadherence. The model demonstrated a C-index of 0.779, and the ROC curve showed an area under the curve (AUC) of 0.78. Calibration curve analysis revealed good model consistency, and KNN validation yielded high precision with an AUC of 0.9978 and a PR AUC of 0.9963. Conclusion: The developed prediction model for medication nonadherence in UC patients demonstrates robust predictive and calibration capabilities. This model may aid healthcare professionals in identifying high-risk patients and supporting timely clinical interventions.
    
    VL  - 14
    IS  - 2
    ER  - 

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