P717 The use of combination biologic therapy in inflammatory bowel disease: A single tertiary-centre experience
Bibliographic record
Abstract
Biologic therapy has revolutionised the care of inflammatory bowel disease (IBD). More recently, newer biologics have been approved. Despite multiple options, clinical remission rates at 1 year are approximately 40% for any single biologic agent. In addition, questions surround the efficacy of newer agents in controlling extra-intestinal manifestations (EIMs). This has raised interest in whether combination biologic therapy with agents of different mechanisms of action (MOA) can be used safely to increase overall efficacy and to control EIMs. The aim was to describe the clinical experience in IBD patients treated with combination biologic therapy at the University of Calgary IBD unit. A retrospective single-centre cohort study was performed at the University of Calgary of adult (≥18 years) IBD patients receiving combination biologic therapy All patients received ‘add on’ biologic therapy either to control medically refractory disease or to treat EIMs not controlled by a single agent. Safety and efficacy of the combination biologic therapy was assessed. We identified 10 patients (9 Crohn’s disease (CD), 1 ulcerative colitis (UC)) were treated with combination biologic therapy with mean follow-up of 64.8 weeks (range 10–118 weeks). All patients had failed > 3 previous biologics, All patients had a biologic added to existing biologic therapy. Primary indication to add a second biologic was medically refractory disease in 6 and control of EIMs in 4. Combinations of biologics used included: vedolizumab and adalimumab (n = 3); vedolizumab and infliximab (n = 3); vedolizumab and golimumab (n = 2); vedolizumab and certolizumab (n = 1); and ustekinumab and infliximab (n = 1). Of the 6 who were on dual biologic therapy for medically refractory disease 3/6 (50%) demonstrated clinical improvement, and 3/6 (50%) demonstrated endoscopic response. Two patients (1 CD; 1 UC) underwent intestinal resection, but neither experienced a postoperative complication.The four whose primary indication was to control EIMS; anti-TNF therapy was added to vedolizumab and all patients had complete resolution of their EIMs. One patient developed community acquired pneumonia (CAP) on high-dose steroids, golimumab, and vedolizumab. All other combinations were well tolerated during the follow-up period. In this small, highly selective cohort of patients with IBD, a variety of combinations of biologic therapy were well tolerated. One patient developed CAP. The combination proved to be a successful strategy to control EIMs when anti-TNF therapy was added to vedolizumab. Further studies are needed to assess the comparative efficacy of combination strategies and long-term safety compared with single agents.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".