A110 THE EFFECT OF SMOKING ON INDUCTION OF REMISSION OR RESPONSE TO ANTI-TUMOR NECROSIS FACTOR THERAPIES IN PATIENTS WITH CROHN’S DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
BACKGROUND: Anti-tumour necrosis factor alpha (TNF) therapies including infliximab, adalimumab and certolizumab, have been proven to be effective for the induction of response and remission in patients with Crohn’s disease. Smoking, a modifiable factor, has been demonstrated to have a negative influence on disease activity. AIMS: We conducted a systematic review and meta-analysis to examine the association between smoking status and clinical outcomes (remission and response) in individuals with Crohn’s disease treated with anti-TNF therapies. METHODS: MEDLINE, EMBASE and PubMED were searched from inception to July 2016. References and conference abstracts were searched to identify additional studies. We included observational studies that reported smoking status and clinical outcomes (remission and response) related to the use of anti-TNF therapies in patients with Crohn’s disease. Study selection and data extraction were performed by two independent reviewers. Methodological quality was assessed using modified version of the Newcastle Ottawa Scale. The primary outcome was remission and defined as less than 150 CDAI points or less than 4 HBI points. The secondary outcome was response and defined as a reduction of 70 CDAI points or decrease of 3 or more HBI points. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated. Meta-analysis was used to pool the relative risk from identified studies with a random effects model. RESULTS: Of the 1211 studies reviewed for eligibility and data extraction, we included fifteen observational studies in the final meta-analysis. There was no statistically significant association between smoking and induction of remission (RR: 0.77; 95% CI: 0.56 to 1.05) and response (RR: 0.96; 95% CI: 0.89 to 1.03) to infliximab and adalimumab. Subgroup analysis were conducted to determine the source of heterogeneity. Prior exposure to anti-TNF therapies, type of anti-TNF therapies (infliximab vs. adalimumab), and disease behaviour (luminal vs. fistulising) was not a source of heterogeneity. CONCLUSIONS: Smoking did not have a significant effect on the induction of clinical response or remission in patients with Crohn’s disease that were treated with anti-TNF therapies. Clinicians should therefore not base their decision to use anti-TNF therapies, such as infliximab and adalimumab, in patients with Crohn’s disease solely on the individual’s smoking status. FUNDING AGENCIES: None
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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 | 0.017 | 0.043 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.048 |
| Bibliometrics | 0.008 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".