Purine analog for the prevention of postoperative recurrence of Crohnʼs disease
Bibliographic record
Abstract
Peyrin-Biroulet L, Deltenre P, Ardizzone S, et al. Azathioprine and 6-mercaptopurine for the prevention of postoperative recurrence in Crohn's disease: a meta-analysis. Am J Gastroenterol. 2009;104:2089-2096. Postoperative recurrence of Crohn's disease (CD) is a major clinical problem for gastroenterologists and their patients. Endoscopic recurrence, which precedes clinical recurrence, has been reported in up to 90% of patients undergoing resection.1,2 To prevent recurrence, patients are routinely placed on antibiotic therapy (metronidazole for 3 months) with or without 5-aminosalicylate compounds. Studies examining the efficacy of purine analogs compared to conventional therapy have yielded conflicting results.3,4 Peyrin-Biroulet et al performed a meta-analysis of randomized controlled trials to define the effect of purine analogs (azathioprine or 6-mercaptopurine) for the prevention of postoperative CD. The control group consisted of placebo or mesalamine. Since only studies reporting the clinical and endoscopic recurrence were included in this meta-analysis, 11 out of 15 potentially eligible articles were excluded. There were a total of 433 patients from four clinical trials: 198 patients were treated with purine analogs and 235 patients received controls. For clinical recurrence rate at 1 year, the mean difference between the two groups was 8% (95% confidence interval [CI]: 1%-15%) with a number needed to treat (NNT) of 13; at 2 years, the mean difference between the two groups was 13% (95% CI: 2%-24%) with an NNT of 8. For endoscopic recurrence, three studies involving 293 patients with endoscopic evaluations performed at 1 year were included in the analysis. There were 129 patients in the purine analogs group and 164 in the control arms. At 1 year the mean difference in recurrence rate between the two groups was 15% (95% CI: 1.8%-29%) with an NNT of 7. The efficacy at 2 years was not evaluated since only one study was available for this endpoint.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".