P537 The impact of early disease control with vedolizumab on surgery rates among patients with Crohn’s disease: a post-hoc analysis of the GEMINI trials
Notice bibliographique
Résumé
In Crohn’s disease (CD), short disease duration is associated with greater response to anti-tumour necrosis factor α therapy. The impact of disease duration on surgery rates in vedolizumab-treated patients with CD has not been established. A clinical decision support tool (CDST) was developed using data from the GEMINI 2 trial and validated with data from the VICTORY consortium to predict clinical and endoscopic remission with vedolizumab in CD.1 Whether earlier treatment with vedolizumab reduced the risk of CD-related surgery in patients with low, intermediate, or high probability of response to vedolizumab was assessed. Individual patient data from GEMINI 2 and the open-label GEMINI long-term safety studies were evaluated. Early and late disease were defined as ≤2 vs. >2, ≤3 vs. >3, and ≤5 vs. >5 years of disease duration. CD-related surgery was defined as bowel resection and colectomy. Patients were stratified according to the CDST into low, intermediate, or high probability of response to vedolizumab, and logistic regression and Cox-proportional hazard analyses were used to assess the impact of early disease intervention with vedolizumab in these subgroups. Odds ratios (ORs) with 95% confidence intervals (CIs) are reported. A combined total of 1253 patients with CD from the GEMINI studies were included (mean [SD] age, 36.4 [12.4] years; 55.1% female), with 113 (9.0%) requiring CD-related surgery during the 7-year follow-up period. Surgical rates were 12.9%, 8.1%, and 6.0% for the low, intermediate, and high probability of vedolizumab response groups based on the CDST. Patients with low probability of response had a 2-fold (hazard ratio, 2.32; 95% CI, 1.29–4.30) increased risk of surgery while receiving vedolizumab relative to the high probability of response group. Overall, there was a trend of lower rates of CD-related surgery among patients treated earlier in their disease course (table). For the low probability of vedolizumab response group, patients with CD with a disease duration of ≤5 years had 39% lower odds of requiring CD-related surgery compared with patients with disease duration >5 years (OR, 0.61; 95% CI, 0.36–0.99). This post hoc analysis suggests that treatment of patients with CD with vedolizumab earlier in their disease course is associated with lower rates of surgery up to a 7-year time horizon, regardless of baseline probability of response to vedolizumab. Table. CD-Related Surgery Stratified by Probability of Response to Vedolizumab and Disease Durationa Reference 1. Dulai PS, Boland BS, Singh S et al. Development and validation of a scoring system to predict outcomes of vedolizumab treatment in patients with Crohn’s disease. Gastroenterology 2018;155:687–695.e10.
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 | 0,017 | 0,020 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,011 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 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 ».