Persistence With Immunomodulator Monotherapy Use And Incidence of Therapeutic Ineffectiveness Among Users of Immunomodulator Monotherapy in IBD
Bibliographic record
Abstract
OBJECTIVES: Immunomodulator (IM)-based monotherapy with thiopurines or methotrexate is being increasingly supplanted in the management of moderate-to-severe IBD by more efficacious biologic agents. However, given their low cost, IMs may still have a selective role in this setting. METHODS: We used a Canadian population-based dataset of persons with IBD spanning from 1996 until 2014 to assess the initiation and continued use of IM monotherapy, the incidence of outcomes associated with ineffectiveness (defined as IBD-related hospitalization, IBD-resective surgery, systemic corticosteroid (CS) use, or the need for biologic therapy), and the demographic and disease-related characteristics associated with persistence on IM monotherapy and IBD-associated adverse outcomes. RESULTS: There were 3312 persons diagnosed with IBD (1480 CD, 1832 ulcerative colitis (UC)) in the study period. The cumulative incidence of IM monotherapy use at 5 years was 46 % for CD and 24.9% for UC. Approximately one-third remained on IM monotherapy continuously for 5 years or more. Roughly three-quarters of IM users with a history of corticosteroid use had at least a 50% reduction in corticosteroid exposure in the year following IM initiation. Thirty-five percent of those with CD and 30% with UC had not developed evidence of therapeutic ineffectiveness within 5 years of IM initiation; people with no history of prior corticosteroid use, no IBD hospitalizations, and persons with CD initiating IM therapy after age 40 were less likely to have an episode of therapeutic ineffectiveness while on IM monotherapy CONCLUSIONS: Although the majority of persons who are initiated on IM monotherapy discontinue medications and/or have evidence of therapeutic ineffectiveness a significant minority remain free of these outcomes over many years of therapy.
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".