Notice bibliographique
Résumé
Introduction:The optimal therapeutic approach to ileocecal Crohn's disease (CD) remains unclear.Aims & Methods: The objective of this study was to compare infliximab with laparoscopic ileocecal resection in patients with thiopurine or steroid refractory recurrent CD of the terminal ileum, with respect to quality of life (QoL) and costs.A multicentre randomised controlled, open-label trial was performed in 33 centres in the Netherlands and the UK.Adult patients with CD of the terminal ileum who failed 4 3 months of thiopurine treatment or steroids without signs of a critical stricture were randomised to infliximab or laparoscopic ileocecal resection.Patients with a prior ileocecal resection, a diseased length 4 40 cm, abdominal abscesses or fluid collections or an American Society of Anaesthesiologists (ASA) score of III or IV were excluded.The primary endpoint was QoL measured by the Inflammatory Bowel Disease Questionnaire (IBDQ) at one year follow-up.Furthermore, the mean direct costs per individual patient were prospectively documented and analysed according to intention-to-treat until one year after start of treatment.Dutch Trial Registry NTR1150.Results: Between May 2008 and October 2015, 143 patients were randomised (32.9% male) with a median age of 27.0 years (interquartile range (IQR) 22.0-40.0).Eventually, 65 patients started with infliximab treatment and 70 patients were operated.On April 28th 2016, 96.5% of the patients have completed followup.At baseline, the mean difference (MD) in IBDQ score was 4.9 points in favour of the resection group.After correction for the baseline difference, the MD at one year follow-up was 5.8 points in favour of resection (95% confidence interval (CI) À4.7 to 16.3, p ¼ 0.28).The mean direct total costs per patient at one year were E14,589 in the infliximab group and E10,318 in the resection group (MD 04,270, 95% CI 01,325 -07,126, p ¼ 0.005).Infliximab was stopped in 21 patients (30.0%) due to intolerance or insufficient response, 13 of whom underwent an ileocecal resection after a median time of 27.0 weeks (IQR 11.0-33.5)after start of infliximab treatment.CD related serious adverse events in terms of Clavien Dindo IIIb complications occurred in three patients (4.1%) in the laparoscopic ileocecal resection group and in one patient allocated to infliximab eventually going for surgery.Three patients (4.1%) in the resection group were started on infliximab within one year.Readmissions (for flares or additional surgery or dilatation) during follow-up were comparable (21.4% of patients in the infliximab versus 17.8% in the resection group).Conclusion: QoL at one year was not significantly different between the laparoscopic ileocecal resection and infliximab group.Given the lower bound of the 95% CI, laparoscopic ileocecal resection can be considered a non-inferior alternative for infliximab treatment at significantly lower cost.
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 | 0,000 | 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 | 0,000 |
| 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) | 0,001 | 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; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».