P703 Clinical, radiographic and endoscopic remission with vedolizumab treatment in Crohn’s disease
Bibliographic record
Abstract
Vedolizumab (VDZ) is a gut-specific α-4-β-7 integrin antagonist that has demonstrated efficacy in randomised controlled trials to induce and maintain clinical response and remission in moderate-to-severe Crohn’s disease (CD) randomised controlled trials. The aim of this study was to evaluate the symptomatic and objective response and remission rates achieved with VDZ therapy in CD in a large tertiary care cohort. A retrospective cohort study was performed at the University of Calgary with adult (≥18 years) CD patients receiving VDZ induction between 2012 and 2017. The primary outcome was clinical or objective remission at 3, 6, and 12 months after induction. Clinical remission was defined by complete absence of symptoms and no need for corticosteroids. Objective remission was defined by steroid-free endoscopic mucosal healing or complete normalisation of radiographic appearance on contrast-enhanced ultrasound or CT/MR enterography. A total of 122 patients were included. Mean follow-up was 43.4 weeks (SD 30.8 weeks). Sixty-nine percent (84/122) of patients had previously failed anti-TNF therapy; 18.9% (23/122) had failed at least 3 previous biologic therapies. Steroid-free clinical remission at 3, 6 and 12 months was 19.8% (22/111), 22.1% (21/95), and 22.1% (15/68), respectively. Steroid-free endoscopic or radiographic remission occurred in 11.5% (6/52), 21.2% (14/66), and 18.9% (7/37) patients at 3, 6, and 12 months, respectively. Mucosal healing on endoscopy was achieved by 22.2% (6/27), 33.3% (14/42), and 25.9% (7/27) of patients at 3, 6, and 12 months, respectively. 109 CD patients with symptomatic response within 6 months to VDZ induction therapy were followed for a mean duration of 46.3 weeks (SD ± 31.3 weeks). Composite loss of response occurred in 36 patients (33.0%) in follow-up at a mean time of 35.2 weeks (± 20.9 weeks). Adverse events (AE) were reported in 35 patients (28.7%). The most common AE were infections (16/122, 6.6%) and infusion reactions (8/122, 6.6%). Serious adverse events were reported in 8 patients (6.6%). Two deaths occurred in the cohort: one patient developed cholangiocarcinoma (pre-existing primary sclerosing cholangitis) and a second patient died from metastatic renal cell carcinoma (diagnosed prior to initiation of VDZ). Clinical and objective (endoscopic or radiographic) response and remission with vedolizumab In this cohort of patients with highly refractory CD, VDZ was effective for inducing steroid-free clinical, endoscopic, and radiographic remission. Loss of response to VDZ occurred in one-third of patients and approximately 20% will discontinue treatment.
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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 | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".