P543 Higher post-induction infliximab serum trough levels are associated with healing of fistulising perianal Crohn’s disease in children
Notice bibliographique
Résumé
There are no data regarding the association of response of fistulising perianal Crohn’s disease (PCD) with serum infliximab (IFX) levels in children. In a multi-centre national inception cohort using prospectively collected data, we aimed to determine serum trough IFX levels at starting maintenance (pre-dose 4) that are associated with healing of fistulising PCD at Week 24. The Canadian Children IBD Network brings together 12 academic paediatric IBD centres from across Canada. Patients younger than 17 years of age presenting with new-onset IBD were enrolled in an inception cohort study. Baseline and longitudinal phenotypic data were prospectively collected using standardised forms, which included a “perianal disease report form”. Consecutive children with fistulising PCD identified via clinical and/or magnetic resonance pelvic examination and treated with IFX between April 2013 and June 2017 and had IFX trough pre-dose 4 levels measured were included in the study. Response was defined as cessation or significant improvement of fistula drainage as defined by physician assessment. Correlation between IFX levels and response of fistulising PCD at Week 24 was examined using Pearson correlation analysis. Area under the receiver-operating characteristic curve (AUROC) was determined, with sensitivity and specificity calculated for the best cut-off of IFX level. A total of 667 children with Crohn’s disease were recruited with 85 (12.7%) patients diagnosed with fistulising PCD. Twenty-seven (mean age 12.5 + 5.1 years, 63% males) of 52 (52%) children with fistulising PCD on IFX had their pre-dose 4 IFX trough levels measured. All patients received three induction doses (median 6 mg/kg) of IFX at 0, 2, 6 weeks with dose 4 given at a median time interval from dose 3 of 50 days. At Week 24, 14 of 27 (52%) patients were classified as respondents with healing/healed PCD while the rest had on-going active fistulising PCD. The median IFX trough pre-dose four level in the respondents was 12.7 μg/ml (interquartile range (IQR) = 6.6–15.5) compared with 5.4 μg/ml (IQR = 2.7–8.4) in the active disease group (p = 0.02). There was a strong correlation between IFX level and healing of fistulising PCD at Week 24 (r = 0.65, p < 0.001). AUROC was 0.80 (95% confidence interval 0.64–0.97, p = 0.007) for pre-dose four level to predict response of fistulising PCD at Week 24, and a level of 12.7 μg/ml predicted fistula healing at Week 24 with sensitivity 0.62 and specificity 0.65. Following induction phase, higher trough IFX levels are associated with a better outcome for fistulising PCD in children. Our results need to be confirmed in larger prospective studies that include measurements of IFX levels and antibodies during the induction phase.
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 | 0,000 | 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 | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
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 ».