A92 ANTIBIOTICS FOR INDUCTION AND MAINTENANCE OF REMISSION IN CROHN’S DISEASE
Bibliographic record
Abstract
Trials of antibiotic therapy for Crohn’s disease (CD) have produced conflicting results. We performed a systematic review and meta-analysis to determine the efficacy and safety of antibiotics for induction and maintenance of remission in CD. EMBASE, MEDLINE, the Cochrane Library and the Cochrane IBD Group Specialized Register were searched from inception to September 2016. Randomized controlled trials (RCTs) comparing antibiotics to placebo or an active comparator in CD patients were considered for inclusion. Data were analyzed based on intention-to-treat. Risk ratios (RR) and corresponding 95% confidence interval (95% CI) were calculated for dichotomous outcomes. The primary outcome was the number of patients who failed to achieve clinical remission. Methodological quality was assessed using the Cochrane risk of bias tool. GRADE was used to assess the overall quality of the evidence for the primary outcome. Fourteen RCTs (n = 1469 patients) were eligible. Two trials were rated as high risk of bias (no blinding). Eight trials were rated as unclear risk of bias and 4 trials were rated as low risk of bias. Ciprofloxacin, metronidazole, clarithromycin, rifaximin and cotrimoxazole were evaluated at therapeutic doses. Comparisons included antibiotic vs. placebo, antibiotic vs. steroid, antibiotic vs. placebo in addition to usual therapy and antibiotic vs. placebo in addition to biologic therapy. A pooled analysis of 8 placebo-controlled RCTs (801 patients) showed no significant difference in clinical remission at 6 to 10 weeks. Fifty per cent (267/535) of antibiotic treated patients failed to enter remission compared to 59% (158/266) of placebo patients (RR 0.87, 95% CI 0.75–1.01; moderate quality evidence). A pooled analysis of two placebo-controlled studies (155 patients) showed no statistically significant difference in relapse rates at 52 weeks. Forty-five per cent (37/83) of antibiotic treated patients relapsed compared to 57% (41/72) of those assigned to placebo (RR 0.87, 95% CI 0.52–1.47; low quality evidence). There were no statistically significant differences between antibiotics and placebo in the proportion of patients with adverse events (RR 0.87, 95% CI 0.75–1.02; 9 studies; 852 patients), serious adverse events (RR 1.12, 95% CI 0.26–4.76; 4 studies; 555 patients), or withdrawal due to adverse events (RR 0.86, 95% CI 0.57–1.29; 9 studies; 858 patients). Antibiotics are ineffective for induction or maintenance of remission in Crohn’s disease. 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 | 0.024 | 0.059 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.014 | 0.021 |
| Bibliometrics | 0.012 | 0.009 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.005 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
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".