P495 Intensified infliximab rescue therapy for acute severe ulcerative colitis does not improve long term colectomy-free survival
Bibliographic record
Abstract
Background: Infliximab (IFX) is an effective rescue therapy for hospitalized steroid refractory acute ulcerative colitis (ASUC). Treatment response is associated with serum IFX trough levels. Intensified dosing regimens with escalated dose and/or shortened interval are increasingly used to compensate for the higher inflammatory burden and drug clearance. Our study aims to determine if intensified IFX induction regimen improves colectomy-free outcomes and identify predictors of long term outcomes. Methods: A retrospective review was performed between July 2010 and May 2016 at McGill University hospitals. All hospitalized adult patients who received at least one infusion of IFX as rescue therapy for steroid refractory ASUC were identified through our pharmacy drug database. We compared standard inductions with 5mg/kg vs 10mg/kg as well as shortened induction interval (i.e. completion of induction within 4 weeks). The primary outcome was the colectomy rate at 2 years. Baseline clinical parameters and dosing regimen were explored with regression analysis. Results: 72 patients (38% female, mean age 41) were identified. 37 patients (51%) received standard 5 mg/kg IFX induction and 35 received 10 mg/kg. 5 patients received shortened induction interval with IFX 10mg/kg. Baseline clinical parameters were well matched among various regimens. The 30-day and 2-year colectomy rate in our cohort was 6.9% and 15.2% respectively. 2-year colectomy-free survival was not significantly different between the standard (86.5%) and escalated (82.9%) dose IFX induction (p=0.388) whereas the shortened induction was associated with lower colectomy-free rate (40% versus standard induction 88.1%, p<0.001). Hemoglobin ≤90 g/L (OR 4.8 [95% CI: 1.2–19.1], p=0.03), albumin <30 g/L (OR 7.9 [95% CI: 1.5–40.1], p=0.01) and a short IFX induction regimen (OR 11.1 [95% CI: 1.6–76.6], p=0.015) were all associated with increased risk of colectomy at 2 years in univariate regression analysis. Albumin <30 g/L remained significant in multivariate modelling (p=0.03). Figure 1. Colectomy free survival. Infliximab 5 versus 10 mg/kg induction. Figure 2. Colectomy free survival. Short versus standard interval induction. Conclusions: Use of intensified infliximab rescue therapy did not improve 2-year colectomy-free survival in this cohort. Tailored use in high risk patients such as those with low albumin and hemoglobin may be beneficial although this needs to be validated in prospective clinical trials.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| 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 | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".