Biological therapy in Crohnʼs disease: Is it an issue of how hard you strike or how fast you strike?
Bibliographic record
Abstract
D'Haens G, Baert F, van Assche G, et al, and the Belgian Inflammatory Bowel Disease Research Group, North-Holland Gut Club. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial. Lancet. 2008;371:660–667. D'Haens et al recently published the results of an open label, randomized, multicenter study evaluating 2 distinct treatment algorithms in 129 patients with moderately to severely active Crohn's disease (CD) (Crohn's Disease Activity Index [CDAI] 220-450) who were within 4 years of diagnosis and had never been treated with systemic steroids, immunomodulators, or biologic therapy. Patients were randomized to treatment using either the traditional step-up approach or a more aggressive early combined immunosuppressive (top-down) approach. In the conventional step-up approach, patients were treated with corticosteroids (prednisone or budesonide) as first-line therapy and azathioprine was added to the regimen for patients who required repeated courses of steroids or became steroid-dependent. Infliximab was eventually added if these therapeutic interventions failed (i.e., immunosuppression failure). In the top-down approach, patients received infliximab as a 3-dose induction regimen (infliximab 5 mg/kg; 3 infusions at weeks 0, 2, and 6) along with azathioprine (2.0–2.5 mg/kg) followed by infliximab in an on-demand fashion if symptoms recurred or worsened. Patients who were intolerant to azathioprine were switched to methotrexate 25 mg SC weekly. Systemic steroids were only added if patients did not respond to the combination of infliximab and azathioprine.
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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 | 0.005 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".