SP125THE STEROID TAPERING IN ANCA VASCULITIS EVALUATION STUDY (STAVE) 2: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
INTRODUCTION AND AIMS: Relapses of ANCA-associated vasculitis (AAV) are associated with death, decreased renal function, and end-stage renal disease. Whether longer-term treatment with glucocorticoids (GC) reduces the risk of relapse is unclear. Our objective was to determine the association between duration of therapy with GC and relapse rate in patients with AAV. METHODS: Systematic review of studies with patients with AAV treated with a predefined duration of treatment with GC. MEDLINE, EMBASE, Cochrane Clinical Trials, and the Grey Literature were searched from January 1, 2008 until May 26, 2016 without language restriction. Studies were included if duration of GC use was specified a priori and patients were followed for a minimum of 18 months. Meta-analysis was completed on calculated relapse rates using a random-effects model of DerSimonian and Laird. RESULTS: Twenty-four studies met inclusion criteria consisting of 2272 patients of which 13 (54%) discontinued GC in less than one year. All patients received additional non-GC immunotherapy for induction and 3 studies (<10% of patients) included patients with GC maintenance therapy alone. The pooled relapse rate was 14.3 per 100 patient years (95% CI 4.5 - 24.0). Relapse rate was greater in studies with early (19.1 per 100 patient years 95%, CI 4.0 - 34.2) versus late (relapse rate 10.9 per 100 patient years 95%, CI -1.9 - 23.6) discontinuation of GC. Relapse was also more frequent when discontinuation of GC at any time was compared to no discontinuation (20.7 per 100 patient years, 95% CI 6.8 - 34.5 versus 8.0 per 100 patient years, 95% CI 5.7 - 21.7). Meta-regression confirmed that discontinuation of GC and greater proportion of PR3+/c-ANCA positive patients were associated with higher relapse rates. No material difference in the results was seen on the basis of how the relapse rates were calculated. CONCLUSIONS: Early discontinuation and discontinuation of GC at any time were associated with an increase in relapse rates in patients with AAV. The clinical severity and consequences of the excess relapses are not well studied. Randomized controlled trials are needed to determine optimal GC administration in patients with AAV.
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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 | 0.012 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.023 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".