Positioning Treatments for Ulcerative Colitis: A RAND Appropriateness Panel
Notice bibliographique
Résumé
Introduction: Therapeutic options for the treatment of ulcerative colitis (UC) have increased recently. However, there is a relative lack of comparative effectiveness data to support decisions regarding choice of therapies in UC. We therefore applied the RAND Appropriateness Method toward establishing the appropriateness of treatment positioning for UC. Methods: A comprehensive literature review was performed regarding the use of current medical therapy in mild and moderate UC. This review was presented to an expert panel comprised of 14 IBD experts from around the world. 225 scenarios were rated for the appropriateness of various UC treatments on a 1-9 scale (1-3 inappropriate, 4-6 uncertain, 7-9 appropriate) using a modified Delphi method through a web-based survey. The group subsequently met to discuss and re-rate the scenarios. Disagreement was assessed using a validated index, and scenarios with disagreement were automatically rated “uncertain”. Results: There was agreement amongst the panel in 224/225 scenarios. The scenario in which there was disagreement related to the use of steroids in a patient with left sided or extensive colitis who was losing response to a second anti-TNF agent. Referral for surgery was rated “appropriate” in 4 scenarios, generally in the setting of failed biologic therapy, and “inappropriate” in 23 scenarios, mostly relating to mild or limited disease. The role of surgery in patients who still had treatment options available after failure of some treatments was often deemed “uncertain”. There was also uncertainty about the addition of thiopurines or steroids in the context of failing biologic therapy, and about the role of dose escalation of vedolizumab for primary non-response; escalation for secondary loss of response was generally deemed appropriate. The use of anti-TNF therapy or vedolizumab in steroid-dependent and thiopurine-resistant patients was generally deemed appropriate. Similarly, switching between vedolizumab and anti-TNF in the context of treatment failure was generally considered “appropriate”. Conclusion: Despite there being limited data to guide positioning of UC treatments, there was general agreement that both anti-TNF and vedolizumab were appropriate options in a wide variety of clinical scenarios. The introduction of new therapies has likely made referral for surgery less appropriate than previously and has made the appropriateness of steroids and thiopurines less clear in some scenarios.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 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) | 0,000 | 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 tête enseignante, 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 ».