A219 TRENDS IN TNF-ALPHA INHIBITOR UTILIZATION IN CHILDREN WITH IBD DURING THE LAST 10 YEARS: 2009–2018
Notice bibliographique
Résumé
Since the last decade, anti-TNF have been increasingly used in the treatment of inflammatory bowel diseases (IBD), but the pattern of use is still not completely defined, especially in the pediatric population. We aimed to define the pattern of use of these monoclonal antibodies and the associated factors during the past ten years. We conducted a cross-sectional analysis of consecutive children with IBD (Crohn’s disease (CD), ulcerative colitis (UC) or unclassified colitis (IBDU)) at CHU Sainte-Justine who had received a treatment with an anti-TNF (Infliximab (IFX) or Adalimumab (ADA)) between January 2009 and October 2018. The primary outcome was the time between IBD diagnosis and the initiation of TNF-alpha inhibitor over the years. The secondary outcomes were the proportion of patients receiving that treatment within three months of diagnosis (early treatment), and the factors associated with early initiation (< 3 months after IBD diagnosis). Among the 925 patients diagnosed between January 2009 and October 2018, [(median (IQR) age at diagnosis 13.9 (4.5) years; 49% female; CD (n=622), UC (n=174), IBDU (n=129)], a total of 509 (55.0%) were exposed to anti-TNF. The median (IQR) PCDAI at diagnosis was 32.5 (20.0) for CD, and the median (IQR) PUCAI was 50.0 (35.0) in UC/IBDU. The median (IQR) age at start of anti-TNF was 14.1(4.5) years. The first exposition to anti-TNF was IFX (n=373), or ADA (n=46). Overall, the median (IQR) interval between IBD diagnosis and the initiation of TNF-alpha inhibitor was 117 (346) days. The median (IQR) interval was 354.0 (940.0) days for patients diagnosed in 2009–2010 and declined to reach 26.0 (101.0) days in 2017–2018. The rate of early treatment (<90 days) was 4.8% in 2009 and gradually increased to reach a maximum of 42.9% in 2018 (Table 1). In the cohort as a whole, the proportion of early treatment with anti-TNF was higher for CD (27.0%) and UC (31.0) than IBDU (6.9%), P<0.0001. A younger age at diagnosis was associated with an earlier start of anti-TNF (Hazard ratio = 1.40 (95% CI = 1.13–1.74); P= 0.0024). (Figure1) More than 50% of children are exposed to anti-TNF after a median follow-up of 4.1 years. Over the last few years, anti-TNF, are being used earlier in the course of IBD in children. A long-term follow-up of this cohort would be useful to assess whether the early anti-TNF approach impacts the long-term durability of remission and the long-term probability to remain under these drugs. Table 1: Change in Early Administration of Anti-TNF (Within 6 Months of IBD Diagnosis) During the Period 2009–2018 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 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».