Glucocorticoids Are Always Under Suspicion — Is the Perception of Their Risks Unbiased?
Bibliographic record
Abstract
In this issue of The Journal , Best, et al 1 report from their retrospective observational cohort study the associations between the usage of oral glucocorticoids (GC) and the incidence and cost of potential adverse effects (AE) of this medication in rheumatoid arthritis (RA). They included 84,357 patients from a US medical database. The highest cumulative oral GC dose (> 1.8 g prednisone equivalent) during a “baseline period” of 1 year (so on average, > 5 mg of prednisone daily during that year) was associated with an increased risk of any potentially GC-associated AE during the directly following “evaluation period” of 1 year, compared to no GC exposure. In their view, these results suggest that all efforts (such as earlier implementation of GC-sparing treatment) should be made to avoid high-dose and chronic oral GC therapy. This study adds to the longstanding debate on risks and benefits of GC in RA. North American publications tend to underscore the risks, whereas many European researchers plead that the toxicity of low-dose GC therapy in RA is frequently overestimated, while its benefits are downplayed. This transatlantic divide does not have a parallel in clinical practice: on both sides of the Atlantic, GC therapy is frequently applied. The CORRONA registry, a US-based longitudinal registry of patients with RA (n = 25,000), shows that about 30% of its patients with RA use a GC2. In an older US study, 35.5% of 12,749 patients with RA were currently using GC, and the lifetime exposure was 65.5%3. Observational studies on AE of GC, like this one by Best, et al 1, intrinsically are associated with a number of methodological issues, obscuring interpretation of results. Here, we will address 3 issues: 1. Are all negative events that occur during GC therapy due to GC? 2. May … Address correspondence to Dr. J.W. Jacobs, University Medical Center Utrecht, G02.228, Box 85500, Utrecht 3508 GA, the Netherlands. E-mail: j.w.g.jacobs{at}umcutrecht.nl
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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 | 0.025 | 0.156 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.003 | 0.009 |
| Scholarly communication | 0.013 | 0.012 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.019 | 0.023 |
| Insufficient payload (model declined to judge) | 0.005 | 0.003 |
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".