A40 IBD PATIENTS RECEIVING INFLIXIMAB IN COMBINATION WITH AN IMMUNOMODULATOR ARE LESS LIKELY TO DEVELOP SECONDARY LOSS OF RESPONSE
Notice bibliographique
Résumé
Anti-TNF therapy is well established in the treatment of moderate to severe Crohn’s disease (CD) and ulcerative colitis (UC). Therapeutic effect may wane over time leading to secondary loss of response that can be overcome with dose escalation. Data on rate of secondary loss of response is extremely limited. We sought to determine real-world rates of secondary loss of response to anti-TNF therapy in CD and UC and to identify patient and disease factors predictive of loss of response. All 23 prescribers of anti-TNF medications for IBD in Manitoba agreed to participate in the study. Charts of biologic-naive patients started on anti-TNF therapy between 2005 and 2016 were reviewed and demographics, disease characteristics, and IBD treatments recorded. Secondary loss of response was defined by the use of augmented dose anti-TNF therapy after a minimum of 90 days on standard dose anti-TNF. Survival curves were constructed and statistical analysis conducted using Student’s t-test, chi squared test, and log rank test. 670 patients started anti-TNF therapy during the period in question (483 CD, 182 UC, and 5 IBD-U). 233 CD subjects (48.2%) had penetrating disease while 92 UC subjects (50.5%) had pancolitis. Mean age at diagnosis was 29.4 years and 50.0% of subjects were female. Secondary non-responders did not differ from the overall anti-TNF cohort in disease phenotype or demographics. No differences in IBD-related surgeries, hospitalizations, or inflammatory markers prior to initiating anti-TNF therapy were observed. Mean duration of follow up was 32.5 months. Secondary loss of response occurred in 9% of subjects by 6 months, 25% by 12 months, and 39% by 24 months. Thereafter response was durable, with only an additional 4% drop off over five years of treatment. There was a trend toward lower loss of response among infliximab users, but this did not reach the level of significance (p=0.07). Time to loss of response was significantly greater among anti-TNF subjects receiving concomitant immunomodulators (p=0.006). The beneficial effect of combination therapy was limited to infliximab subjects (p=0.0002) with no benefit observed among adalimumab users (p=0.80). Secondary loss of response rate did not differ between CD and UC (p=0.51). Over 40% of IBD subjects treated with anti-TNF therapies ultimately lose response and require dose augmentation, with the majority of cases occurring within the first 24 months. Loss of response is significantly less common among infliximab users receiving concomitant immunomodulators. None
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 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 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) | 0,008 | 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 ».