P-036 YI Clinical and Serological Factors Associated With Response to Infliximab in Chronic Refractory Pouchitis and Pouch Complications
Notice bibliographique
Résumé
Pouchitis refractory to first-line therapies and pouch complications remains problematic following colectomy and ileal-pouch anal anastomosis (IPAA) for ulcerative colitis (UC). Evidence for infliximab (IFX) use in this setting and factors predicting its success remain limited. Here, we investigated IFX use in refractory pouchitis and clinical and serological variables associated with treatment response. Patients were identified from the Mount Sinai Hospital IBD and Pelvic Pouch Databases, Toronto, Canada. Clinical, endoscopic and serological data were reviewed from 579 individuals who underwent colectomy and IPAA from 2000 to 2014. Patients with chronic refractory pouchitis and Crohn’s Disease- like outcome treated with IFX were included. Pretreatment parameters were measured within 4 weeks of induction and IFX response at a median of 9 (initial) and 48 weeks (sustained) respectively. Complete response was defined as symptomatic and endoscopic resolution with modified Pouchitis Disease Activity Index (mPDAI) score <5. Partial response was defined as improvement in symptoms with reduction in mPDAI >2. Endoscopic mucosal healing, pouch excision, pouch complications and CRP were recorded. Serum was analyzed for antibodies against Saccharomyces cerevisiae (ASCA), OmpC, CBir1 and perinuclear neutrophil cytoplasm (pANCA). Fisher’s exact testing and Kruskal-Wallis detected differences in clinical and serological variables between subgroups. Logistic regression models were applied to estimate odds ratio (OR) and 95% confidence interval (CI) of clinical and serological factors with initial and sustained clinical response as dependent variables. Results were deemed significant if P-value was ≤0.05. Thirty-one patients were included (33% male; age 32.6 ± 2.6 [mean ± SE]). 26% were on combined therapy with immune-modulator. Seventy-four present achieved post-induction response at median 9 weeks (IQR [6.5–13]) (48% complete, with concomitant mucosal healing). At median 48 weeks (IQR [25–71.5]), 62.6% retained response (29.6% complete). There were significant reductions in mPDAI in the entire cohort from a pre-induction score of 8.5 ± 0.3 to 2 ± 3.4 at final follow-up (mean, SE; P < 0.002) and in CRP from 29.48 ± 6.2 mg/L to 5.76 ± 1.6 mg/L (P < 0.001). Age, gender, smoking, pre-pouch disease extent and CRP did not affect response to IFX. Pretreatment mPDAI score did not significantly affect sustained IFX response but higher pretreatment mPDAI scores were negatively associated with early mucosal healing (P = 0.056; OR = 0.5, 95% CI, [0.2–1.010]). Patients with pretreatment mPDAI >10 were less likely to have initial mucosal healing (P = 0.03). Initial mucosal healing was associated with sustained complete response (P < 0.05; [OR] = 13.2; 95% confidence interval [CI], 1.0–165). Presence of ASCA was associated with higher initial mPDAI (P = 0.016), but no difference in treatment response. IFX responders had a lower number of positive antibody titers (2 positive titers versus 3, mean; P < 0.05). Having >2 positive titers was associated with longer term non-response to IFX though not significantly. IFX was effective in the short- and longer term in patients with chronic refractory pouchitis and pouch complications. Mucosal healing after induction is the strongest clinical association with a complete sustained response to IFX in this group and pretreatment mPDAI may help predict this.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».