Effect of Oral Methylprednisolone on Clinical Outcomes in Patients With IgA Nephropathy
Why is this work in the frame?
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Full frame distilled prediction
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.
- Candidate categories
- none
- Consensus categories
- none
- Domain
- Candidate signal: noneConsensus signal: none
- Study design
- Candidate signal: ObservationalConsensus signal: Observational
- Genre
- Candidate signal: EmpiricalConsensus signal: Empirical
- Teacher disagreement score
- 0.065
- Threshold uncertainty score
- 0.284
- Validation status
machine_predicted_unvalidated·codex-gemma-dda1882f352a
Codex and Gemma teacher scores by category
| 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 | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
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.
- Teacher spread
- 0.331 · how far apart the two teachers sit on this one work
- Validation status
score_only:v0-immature-baseline· verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it
Abstract
Importance: Guidelines recommend corticosteroids in patients with IgA nephropathy and persistent proteinuria, but the effects remain uncertain. Objective: To evaluate the efficacy and safety of corticosteroids in patients with IgA nephropathy at risk of progression. Design, Setting, and Participants: The Therapeutic Evaluation of Steroids in IgA Nephropathy Global (TESTING) study was a multicenter, double-blind, randomized clinical trial designed to recruit 750 participants with IgA nephropathy (proteinuria greater than 1 g/d and estimated glomerular filtration rate [eGFR] of 20 to 120 mL/min/1.73 m2 after at least 3 months of blood pressure control with renin-angiotensin system blockade] and to provide follow-up until 335 primary outcomes occurred. Interventions: Patients were randomized 1:1 to oral methylprednisolone (0.6-0.8 mg/kg/d; maximum, 48 mg/d) (n = 136) or matching placebo (n = 126) for 2 months, with subsequent weaning over 4 to 6 months. Main Outcomes and Measures: The primary composite outcome was end-stage kidney disease, death due to kidney failure, or a 40% decrease in eGFR. Predefined safety outcomes were serious infection, new diabetes, gastrointestinal hemorrhage, fracture/osteonecrosis, and cardiovascular events. The mean required follow-up was estimated to be 5 years. Results: After randomization of 262 participants (mean age, 38.6 [SD, 11.1] years; 96 [37%] women; eGFR, 59.4 mL/min/1.73 m2; urine protein excretion, 2.40 g/d) and 2.1 years' median follow-up, recruitment was discontinued because of excess serious adverse events. Serious events occurred in 20 participants (14.7%) in the methylprednisolone group vs 4 (3.2%) in the placebo group (P = .001; risk difference, 11.5% [95% CI, 4.8%-18.2%]), mostly due to excess serious infections (11 [8.1%] vs 0; risk difference, 8.1% [95% CI, 3.5%-13.9%]; P < .001), including 2 deaths. The primary renal outcome occurred in 8 participants (5.9%) in the methylprednisolone group vs 20 (15.9%) in the placebo group (hazard ratio, 0.37 [95% CI, 0.17-0.85]; risk difference, 10.0% [95% CI, 2.5%-17.9%]; P = .02). Conclusions and Relevance: Among patients with IgA nephropathy and proteinuria of 1 g/d or greater, oral methylprednisolone was associated with an increased risk of serious adverse events, primarily infections. Although the results were consistent with potential renal benefit, definitive conclusions about treatment benefit cannot be made, owing to early termination of the trial. Trial Registration: clinicaltrials.gov Identifier: NCT01560052.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
The record
- Venue
- JAMA
- Topic
- Renal Diseases and Glomerulopathies
- Field
- Medicine
- Canadian institutions
- University Health NetworkUniversity of British ColumbiaHealth Sciences CentreSunnybrook Health Science Centre
- Funders
- Renmin Hospital of Wuhan UniversityShengjing HospitalWest China Hospital, Sichuan UniversityCanadian Institutes of Health ResearchPfizer PharmaceuticalsTongji UniversityGenentechFirst Affiliated Hospital of Zhengzhou UniversityGeorge Institute for Global HealthRenji HospitalHebei Medical UniversityBaotou Medical CollegeTongji Medical College, Huazhong University of Science and TechnologyNational Health and Medical Research CouncilNanjing UniversityPeking UniversityMedical Research CouncilZhejiang UniversitySchool of Medicine, Indiana UniversityRelypsaWuhan UniversityHenan UniversityRuijin HospitalUniversity of LeicesterNanjing General Hospital of Nanjing Military CommandZhengzhou UniversityFresenius Medical Care North AmericaUniversity of British ColumbiaEli Lilly and CompanyPfizerCharles Darwin UniversityDiabetes AustraliaHuazhong University of Science and TechnologyJanssen Research and DevelopmentAkebia TherapeuticsDiabetes Australia Research TrustChina Medical UniversitySanofiHenan University of Science and TechnologyHuashan HospitalRebecca L. Cooper Medical Research FoundationOmeros CorporationDavid Geffen School of Medicine, University of California, Los AngelesPeking University People's HospitalNational Institute of Diabetes and Digestive and Kidney DiseasesPostgraduate Institute of Medical Education and Research, ChandigarhQilu Hospital of Shandong UniversitySichuan UniversityShandong UniversityJohns Hopkins UniversityChugai PharmaceuticalGeneral Hospital of People’s Liberation ArmyMenzies School of Health ResearchShanxi Medical UniversityAmgenFudan UniversityPeking University First Hospital
- Keywords
- MedicineNephropathyRenal functionProteinuriaInternal medicineKidney diseaseGastroenterologyRandomized controlled trialMethylprednisoloneUrologyDiabetes mellitusKidneyEndocrinology
- Has abstract in OpenAlex
- yes