Dose increase patterns in patients treated with tumor necrosis factor antagonists (anti-TNFs) for Crohn's disease (CD) in Canada.
Bibliographic record
Abstract
The efficacy of treatment dosages with adalimumab and infliximab has been demonstrated in several RCTs. It has also been shown that some patients may benefit from increased dosing of these medications. The objective of this analysis was to evaluate dose escalation in CD patients newly initiating anti-TNF therapy in a Canadian real-world setting, and better understand the impact of dose escalation definitions in a large database. CD patients initiating therapy with adalimumab or infliximab between January 2008 and September 2009 were selected from IMS|Brogan Canadian Private Drug Plan Databases. For each patient, weekly doses were calculated for each dosing episode (defined as the time-interval between two prescriptions) of maintenance treatment. For adalimumab, maintenance was defined as all doses after 4 weeks of treatment initiation whereas for infliximab maintenance was defined as all doses after 6 weeks of treatment initiation. Dose escalation was assessed with three different methods: 1) Index vs. last (first maintenance dose compared with last dose), 2) Average dose, and 3) Time-trend. The first method compared the last dose received and the index dose (first maintenance dose). For adalimumab, dose escalation was identified by a one 40 mg unit increase. For infliximab, dose escalation was identified either with an increased number of vials or a shortening of time between dosing episodes (≤ 6 weeks). The average dose method compared the average dose (all dosing episodes) and recommended dose. Adalimumab recommended dose was 40 mg every two weeks; dose escalation being identified by a ≥ 40 mg average every week. As infliximab is prescribed using body weight (not available in databases), the index-dose was used as a substitute for the recommended dose; dose escalation was identified if the average dose exceeded the index dose. The time-trend method used dose escalation definitions of the first method, but the dose from each dosing episode was compared with the index dose; dose escalation was identified if the dose of two consecutive dosing episodes exceeded the index dose.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.007 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".