P365 Biological interventions for induction and maintenance of mucosal healing in Crohn’s disease: A Cochrane systematic review
Notice bibliographique
Résumé
Clinical trials of biologics in Crohn’s disease (CD) have focused on clinical outcomes. Their ability to achieve mucosal healing (MH) is less clear. In this Cochrane review, we synthesised the randomised controlled trial (RCT) data on biologics for inducing and maintaining MH in CD. MEDLINE, EMBASE, Cochrane Library (CENTRAL) and the Cochrane IBD Group Specialised Trials Register were searched to October 2017 for RCTs examining biologics for inducing and/or maintaining MH in CD at 4–26 and >26 weeks, respectively. Secondary outcomes were endoscopic response (ER), safety and quality of life (QOL). Pooled risk ratios (RR) were calculated using a random-effects model. The quality of the evidence was rated using GRADE. The search yielded 7 induction trials (5 low, 2 unclear risk of bias). Infliximab (IFX) was superior to placebo (PBO) for inducing MH at week 10 (RR 8.4, 95% CI 1.2–61, n = 74, low quality), and IFX mono- and combination therapy with azathioprine (AZA) were superior to AZA for inducing MH at week 26 (RR 1.9, 95% CI 1.1–3.1, n = 218, low quality, and RR 2.7, 95% CI 1.7–4.3, n = 232, moderate quality). MH rates did not differ significantly between adalimumab (ADA) and PBO-treated patients, but ADA users were more likely to achieve CDEIS ≤4 at week 12 (RR 1.9, 95% CI 1.2–3.0, n = 123, low quality). Neither natalizumab (RR 2.8, 95% CI 0.4–20, n = 50, low quality), nor ustekinumab (UST) (RR 2.1, 95% CI 0.81–5.4, n = 302, low quality) was superior to PBO for inducing MH, but UST users displayed significantly greater SES-CD reductions in one study (low quality). The search identified 3 maintenance trials, each examining a different biologic (2 low, one high risk of bias). Neither IFX nor ADA was superior to PBO for maintaining MH achieved during induction, but patient numbers were extremely small. Comparable data were not available for UST. Amongst all randomised patients (regardless of MH status at induction completion), only ADA was associated with higher 1-year MH rates than PBO (RR 30.5, 95% CI 1.9–499, moderate quality for ADA; RR 2.4, 95% CI 0.94–6.4, low quality for IFX; RR 2.2, 95% CI 0.86-5.6, very low quality for UST). All 3 biologics displayed a significant benefit for ER at 1 year. Adverse event rates were similar between groups, but one case of progressive multifocal leukoencephalopathy was observed with natalizumab. IFX and UST were associated with improved QOL. The evidence supports the efficacy of IFX for inducing MH (low-to-moderate quality), and of ADA and UST for inducing ER (low quality), in CD. ADA was associated with higher maintenance MH rates than PBO at 1 year, with ADA, IFX and UST displaying significantly higher rates of ER. There is no RCT evidence for certolizumab or vedolizumab.
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 | 0,007 | 0,028 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,013 | 0,011 |
| Bibliométrie | 0,013 | 0,012 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,014 | 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 ».