P0615 STEROID THERAPY IN THE AGE OF INFLIXIMAB (IFX): IMMEDIATE AND 1 YEAR OUTCOME IN NEWLY DIAGNOSED CHILDREN WITH CROHN DISEASE (CD)
Notice bibliographique
Résumé
Introduction: Steroids induce CD remission within 3 months in 58% of adults, but by 1 year only 32% are steroid/surgery free (Gastro 2001;121:255). The use of IFX may have changed patients’ outcomes to steroids. PURPOSE: To determine children’s responses to steroids begun within 30 days of CD diagnosis (dx) and their need for IFX during the 1st year post-dx. Methods: Since January 2002, 18 US/Canadian sites prospectively enrolled newly diagnosed children with IBD in an observational registry. All were managed according to the dictates of their physicians, not standard protocols. The database was searched for children with CD followed for 1 yr who received po/iv steroids within 30 days after dx. Data on use of steroids, immunomodulatory agents (IA), IFX and surgery were prospectively compiled. Children were considered to have a complete response if steroids were successfully stopped by 3 months without requiring IFX or surgery. A prolonged response was defined as no steroids, IFX or surgery in the next 3 quarters (9 months). Results: 47 children (mean age 11.5 yrs, 30 male, PCDAI at dx 32+/−16) started steroids within 30 days of dx. 32 (68%) were on concomitant IA, including 20 who began IA in the 1st month. By 3 months after dx, 29 (62%) had a complete response and another 4 (9%) stopped steroid after adding IFX. Half of these responders also received IA. A prolonged response was seen in 21 (64% of initial responders, 45% of total population), but 11 required additional courses of steroids or IFX and 1 required surgery. Among the 14 subjects not off steroids by 3 months, 9 received steroids in the Quarter 2, 3 in the Quarter 3 and 2 throughout the year. Seven of the 14 were only weaned off steroids after starting IFX, and 1 failed IFX and required surgery. Overall, 16 (34%) subjects received IFX in the year and 18 (38%) required steroids (8), IFX (7) or both (3) in the 4th quarter of observation. Conclusion: 70% of children with CD receiving steroids within 30 days of dx can be weaned off steroids by 3 months, although at times only by adding IFX. While 77% of the cohort is off steroids at 1 year, 21% remain on IFX and 4% have undergone surgery despite widespread use of concomitant IA. Frequency and duration of steroid use is in large measure determined by when IFX is started. While steroid dependence can be decreased by use of IFX, studies are needed to see if IFX leads to better long term outcome in children with CD.
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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 | 0,001 | 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 | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 ».