P689 Biologics utilization in children with inflammatory bowel diseases is higher and earlier than in adults: a report from the epi-IIRN group
Bibliographic record
Abstract
Background: The diagnosis of Inflammatory bowel diseases (IBD) during childhood is associated with a more aggressive and extensive phenotype compared with adults, necessitating early introduction of effective therapy. We aimed to study differences in biologic therapy in pediatric and adult IBD patients in the Israeli population. Methods: IBD cases were identified within the databases of three national health maintenance organizations (HMOs), covering 48% of the Israeli population. Identification as well as differentiation into Crohn's disease (CD) or ulcerative colitis (UC) patients was performed using previously validated algorithms, with the effective date of 31.12.2015. Biologic therapy was determined by pharmacy purchases as recorded by the HMOs; expenses are covered by the national public health care system, ensuring complete unbiased records. Results: Of 19,780 IBD patients identified, 3,445 (17%) commenced on biologics by 31.12.2015. Children (≤18 years) were twice as likely to be treated with biologics (n=326/1005, 32%) vs. adults (n=3119/18,775, 16%; p<0.001). The difference was more pronounced in UC than CD (CD- 41%/25%, UC- 17%/6%, for pediatrics and adults, respectively). Amongst patients diagnosed between 2005–2015, time in months from diagnosis to initiation of biologics was shorter for children (CD- median: 43 [IQR: 16–80], UC- 48 [19–85]), as compared to adults (CD- 54 [25–90], UC- 66 [37–101]; p<0.001 for both CD and UC, Figs. 1 and 2). Figure 1. Kaplan-Meier curves for time from diagnosis to start of biological therapy in CD patients. Figure 2. Kaplan-Meier curves for time from diagnosis to start of biological therapy in UC patients. Conclusions: Biologic utilization in pediatric IBD is significantly higher and earlier than in adults. The possible explanations include a more aggressive and extensive disease, differing clinical practices and the role of biologics for the treatment of growth impairment. This study was supported by a grant from the Leona M. and Harry B. Helmsley Charitable Trust.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 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 | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".