Table 2.

Impact of digital health technologies on disease activity monitoring in patients with IBD

Author, year	Type of Intervention	Outcome Measurements	Duration of Follow-up	Findings
Disease activity assessment
Cross R, 2019	1. TELE-IBD weekly (W) 2. TELE-IBD every other week (EOW) 3. Control – standard of care	Active disease defined as Harvey Bradshaw Index (HBI) 5+ (for CD) or Simple Clinical Colitis Activity Index (SCCAI) 3+ (for UC/indeterminate colitis)	12 months	Disease activity in CD Significant decrease in HBI scores in all groups compared to baseline but no difference between groups (adjusted for race and smoking) Increased remission rates with no difference between groups (54.1% control, 60% EOW and 61% W → 63.5% control, 60.9% EOW and 70.4% W) Disease activity in UC Significant decrease in SCCAI scores from baseline in control but no difference between groups (adjusted for race and smoking). Increased remission rates with no difference between groups (54.1% control, 60% EOW and 61% W → 81.5% control, 78.3% EOW, and 66.7% W)
Cross R, 2012	1. UCHAT – comprised of a home unit, decision support server, and a web-based clinician portal 2. Best available care (BAC)	Seo index with activity index <120 = clinical remission. Scores of 120 to 150, 151 to 220, and > 222 correlate with mild, moderate, and severe disease respectively. A decrease in the index of 35 correlates with clinical response	12 months	Baseline: Seo index scores 115.1 +/− 21.5 BAC vs 127 +/− 42.3 UCHAT (p= 0.24) At 12 months, there were no significant differences: Seo index scores 113.6 +/− 28.0 in BAC v. 122 +/− 39.3 in UCHAT (p = 0.41) Baseline remission 68% BAC and 60% UCHAT (p=0.56) → 77% BAC and 76% UCHAT at 12 mo (p=0.92).
Elkjaer M, 2010	1. Web-based (Constant-Care) 2. Control	SCCAI: disease activity; >5 = relapse Combination of systemic and topical 5-ASA use for disease relapse	12 months	Denmark Web patients experienced more relapses (not significant; mean 1.1 vs 0.8) but were significantly of shorter duration (median 18 days [95% CI 10–21] vs 77 days [95% CI 46–108], p<0.001) At relapse, 100% web pts were started on 5-ASA vs 10% control Ireland Web pts experienced more relapses (39% web-based v. 24% control pts with frequency 0.6 web-based v 0.2 control, p=0.02) but web-group had significantly shorter duration (median 30 days vs 70 days, p<0.03) At relapse, only 15% web pts were started on 5-ASA vs 10% control Both Denmark and Ireland web-groups experienced more relapses but of significantly shorter duration even though in Ireland only 15% of web pts used sufficient 5-ASA treatment vs 100% of web pts in Denmark
Akobeng AK, 2015	1. Mobile-based (telephone consultation) 2. Control	Number of disease relapses defined by abbreviated Pediatric Crohn’s Disease Activity Index (aPCDAI; clinical remission defined as ≤10) and Pediatric Ulcerative Colitis Activity Index (PUCAI; clinical remission defined as <10)	12 months	No significant differences in disease relapses over 24 months
Carlsen K, 2017 (Non-biologic cohort)	1. Web-based (yong.constant-care.com) 2. Control	Patients were required to record data on their disease activity – Pediatric Ulcerative Colitis Activity Index (PUCAI) and the abbreviated Pediatric Crohn’s Disease Activity Index (aPCDAI)	24 months	The time to first step-up in treatment intensity was not significant between the two groups No differences in C-reactive protein, orosomucoid or erythrocyte sedimentation rate between the two groups
Carlsen K, 2017 (Biologic cohort; IFX)	1. Web-based (yong.constant-care.com) 2. Control	Patients were required to record data on their disease activity – Pediatric Ulcerative Colitis Activity Index (PUCAI) and the abbreviated Pediatric Crohn’s Disease Activity Index (abbrPCDAI)	24 months	Significant difference between treatment intervals for the eHealth group versus the control group – significantly longer treatment intervals in the eHealth group. The average IFX dose (mg/kg) was not different between the two groups. Slightly higher antibody levels in eHealth group compared to control but this was not statistically significant.
Del Hoyo, 2019	1. Web-based telemedicine - remote monitoring (G_TECCU) 2. Nurse-assisted telephone care (G_NT) 3. Standard care with in-person visits (G_control)	Clinical remission at 24 weeks (Harvey-Bradshaw index [HBI] for Crohn’s patients; Simple Clinical Colitis Activity Index [SCCAI] for UC patients – for remote check-ups. Partial Mayo score was used for face-to-face visits. Patients with CD and HBI <5 were deemed to be in remission while SCCAI ≤2 was remission for UC patients and a partial Mayo Score ≤2 and no individual Mayo subscore >1 was defined as remission.	6 months	There were no statistically significant differences in probability of remission in G_TECCU compared to G_control in patients with Crohn’s disease or ulcerative colitis.
Heida, 2017	1. Telemonitoring (web-based) 2. Control	Disease activity was assessed by Pediatric Ulcerative Colitis Activity Index (PUCAI) and the shortened Pediatric Crohn’s Disease Activity Index (shPCDAI). Cumulative incidence of disease flares, which was defined as disease activity requiring treatment intensification (e.g., steroid therapy, exclusive enteral nutrition, aminosalicylate dose escalation or introduction of anti-TNF).	12 months	There was no significant difference in the proportion of patients experiencing disease flares between the intervention (33%) and control group (34%).
McCombie, 2020	1. Mobile application (IBDsmart and IBDoc) 2. Control	HBI or SCCAI for disease activity assessment Remission was defined as SCCAI ≤2 or HBI ≤4	12 months	For UC patients, the SCCAI was noninferior at 3, 6, 9, and 12 months of follow-up between the two groups on intention-to-treat analyses. For CD patients, the HBI was noninferior at all time points except for at 9 points in intention-to-treat analyses.
Miloh, 2017	1. Telemonitoring (2-way interactive text messaging [TM]) 2. Control	Clinical score using Pediatric Crohn Disease Activity Index for patients with Crohn’s and Pediatric Ulcerative Colitis Activity Index for patients with ulcerative colitis.	12 months	No significant differences in changes in disease activity between the two groups

HBI: Harvey Bradshaw Index

SCCAI: Simple Clinical Colitis Activity Index

CD: Crohn’s disease

UC: Ulcerative colitis

PCDAI: Pediatric Crohn’s Disease Activity Index

aPCDAI: abbreviated Pediatric Crohn’s Disease Activity Index

shPCDAI: shortened Pediatric Crohn’s Disease Activity Index

PUCAI: Pediatric Ulcerative Colitis Activity Index