DOP021 Immunosuppressive and anti-TNF treatment is associated with a lower risk of migration from B1-to-B3-stage in Crohn’s disease: 10-year follow-up data from the Swiss IBD cohort study
Notice bibliographique
Résumé
Our knowledge on the evolution of disease behaviour remains scarce after the introduction of anti-TNF. We investigated the long-term evolution of B-Stage in CD patients in the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS). Prospectively collected SIBDCS data on all CD patients was analysed regarding B-Stage (B1 = inflammatory, B2 = stricturing, B3 = penetrating) evolution over time according to treatment. We deliberately used an extended definition of penetrating disease, including perianal fistula into B3, due to a substantial morbidity, not exceedingly different to non-perianal fistula (constituting the classical definition of a B3 stage according to Montreal). Of 1471 CD patients, 1042 had a non-B3 phenotype at enrolment, amongst of which 645 never had previously been treated with anti-TNF and thus were eligible for further analysis. Overall, 95.2 and 78.4% of initial B1 patients remained in this stage after 1 and 5 years, respectively. Yet, after 15 years only 48.1% revealed a sustained B1 phenotype with 32.1 and 19.8% having migrated to a B2 and B3 stage, respectively. In multivariate testing, patients aged >40 years at diagnosis were significantly less likely to progress from B1 to B3 (HR 0.378). With regards to treatment with anti-TNF we predefined a separate analysis for patients with initiation of treatment >1 years vs. within 1 year or less prior to the event of stage migration, as the latter may indeed reflect an attempt of treatment escalation in the event of imminent or already having occurred therefore undiagnosed B-stage progression. We found both immunosuppressants (IS) and persistent treatment with anti-TNF to be significantly associated with a decreased likelihood of B1-to-B3 progression as compared with CD patients without treatment with IS and/or anti-TNF. Signifikant Risk factors for B-Stage migration: multivariate analysis. Significant risk factors for a change in disease behaviour over time according to multivariate testing. Significant hazard ratios (HR) are printed in bold type. In our prospective cohort study, we identified a beneficial effect of both, IS and sustained anti-TNF on the risk of B1-to-B3 migration in CD patients on the long-term as opposed to their treatment naïve counterparts or patients having stopped anti-TNF treatment. Evidently, a randomised long-term study would be preferential to investigate the potential of medical interventions on modifying the risk of B-stage migration, due to a high likelihood of selection bias towards more vs. less favourable prognosis in patients in the IS-and-anti-TNF-naïve vs. anti-TNF exposed groups, respectively. Therefore, the results from our study suggest a potentially even more robust beneficial effect of IS and anti-TNF on long-term B-stage migration.
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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 | 0,001 |
| 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 | 0,000 |
| 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 ».