P550 Early 12-week ultrasound response to treatment, used as a predictor of response at 6 months in Crohn’s disease: A prospective cohort study
Bibliographic record
Abstract
Ultrasound (US) is safe and accurate for detecting activity and therapeutic response in Crohn’s disease (CD). Early objective assessment may better guide treatment in a treat to target paradigm. The aim of this study is to evaluate 12-week US response to adalimumab (ADA) induction, as a predictor of US, serologic and endoscopic response at 6 months. Patients with known CD were prospectively recruited from January 1, 2011 to December 31, 2014. Patients with active CD had induction and maintenance therapy with ADA with US and C-reactive protein (CRP) levels measured pre-treatment, at 12 weeks and 6 months. Patients underwent ileocolonoscopy (IC) at baseline. A subset had repeat IC at 6 months. The Simple Ultrasound Score (SUS) was calculated (bowel wall thickness and hyperaemia) at each interval and a Simple Endoscopic Score (SES)/Rutgeert’s score for IC when available. Response at 12 weeks was defined by a reduction in SUS or length of disease. Differences between variables at baseline and 6 months were compared using paired sample t test. Features for non-response including presence of strictures or penetrating complications were recorded at baseline. Forty-four patients were included: 64% (28 of 44) females, 36% (16 of 44) male, with mean age of 42 years. Disease distribution was ileal 38% (17 of 44), 55% (24 of 44) ileocolonic and 7% (3 of 44) limited to the colon. All patients exhibited activity on US at baseline, with a mean SUS of 3.14 (out of 4.63). SES was completed for 22 of 44 patients (50%), mean 6.82, Rutgeert’s score was completed for 11 of 44 patients (25%), mean 3.27, while 18% (8 of 44) were not amenable to endoscopic scoring and 7% (3 of 44) had no baseline IC. The median baseline CRP was 5.7 mg/l. At 12 weeks, 70% (31 of 44) improved while 30% (13 of 44) had no change or worsened. Responders were evaluated at 6 months for response compared with baseline: SUS and SES were significantly improved, SUS was 3.45 at baseline and 1.84 at 6 months (p < 0.001) and SES was 6.77 at baseline and 2.50 at 6 months (p = 0.002). Change in CRP was significant (p = 0.044); but the change in Rutgeert’s score was not (p = 0.178). No significant difference for any comparison amongst the non-responders was detected. Of the responders, 9 of 31 (29%) exhibited high-risk features at baseline, compared with 5 of 13 (38%) in the non-responders. Sonographic response to ADA induction at 12 weeks significantly increases the likelihood of further response at 6 months. Responders also exhibited a significant reduction in CRP. High-risk features on baseline US may indicate increased likelihood for non-response. Measurement of 12-week US response may help guide early treatment optimisation.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
| gpt | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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, unvalidatedLabeled directly by 2 models reading the full record.
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".