Higher Adalimumab Maintenance Regimens Are More Effective Than Standard Maintenance Regimens in Crohnʼs Disease Patients Who Have Failed Infliximab
Bibliographic record
Abstract
Introduction: Most Crohn's disease (CD) patients experience a loss of response (LOR) over time and require dose escalation. The efficacy and safety of treating CD patients with higher maintenance regimens following induction remain unknown. Methods: We conducted a retrospective observational study with CD patients receiving adalimumab for luminal and perianal disease between 2007-2017 at a tertiary care IBD center. All subjects had previously failed infliximab. Patients were categorized according to their maintenance regimen; 40mg weekly, 80mg every other week (EOW) or greater was defined as a high dose maintenance regimen (HD) and 40mg EOW was defined as standard regimen (SD). All patients in HD group were started on high maintenance doses directly after induction. The primary outcome was time to treatment failure, defined as non-response, loss of response (LOR) with no benefit from dose optimization, the introduction of steroids, an adverse event requiring discontinuation or surgery. Secondary outcomes included clinical remission at 3 and 12 months, IBD-related surgery, hospitalization and the need for therapeutic optimization. Results: We identified 39 patients that were started on HD regimens following induction and compared them to 40 patients that received SD maintenance. Clinical and demographic characteristics were similar between both groups. According to a Kaplan-Meier survival curve analysis, time to treatment failure was significantly longer in patients in the HD group (p=0.0015). Patients in the HD group were more likely to achieve clinical remission at 3 and 12 months (89% vs 25%, p < 0.001 and 69% vs 31%, p=0.003, respectively). Patients in the SD group were more likely to require IBD-related surgery or therapy optimization (18% vs 3%, p=0.03 and 55% vs 33%, p=0.05). No difference in adverse events was identified between the groups (31% vs 30%, p=0.94). Conclusion: Higher dose maintenance regimens were more effective than the standard adalimumab maintenance protocol with better short-term and long-term clinical outcomes. No increased safety concerns were observed with higher maintenance dosing.FigureTable: No Caption availableTable: No Caption available
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".