Exposing the Weaknesses: A Systematic Review of Azathioprine Efficacy in Ulcerative Colitis
Bibliographic record
Abstract
Purpose: We performed a systematic review and meta-analysis to evaluate the clinical efficacy of azathioprine or 6-mercaptopurine after standard induction with corticosteroids. We also sought to explore potential sources of clinical trial heterogeneity that may have influenced the results of previous trials. Methods: A comprehensive search of online databases was conducted. Only randomized controlled trials with azathioprine or 6-mercaptopurine within a minimum duration of follow-up of 6 months were selected. Pooled relative risk estimates were calculated for the primary outcome “success of treatment”, defined as clinical remission or significant clinical response or failure to relapse. Results: In total, 6 trials were included in the systematic review and 5 in the meta-analysis. The pooled relative risk estimate, using a random effects model, for “success of treatment” with AZA compared to 5-ASA and/or placebo was 1.42 (95% CI 0.93–2.17, P= 0.109). Using only trials of higher methodology quality (Jadad score >2), the pooled relative risk estimate was 2.05 (95% CI 1.30–3.23, P= 0.002). Conclusion: In summary pooling the results of the two trials of highest methodologic quality demonstrated a modest efficacy of azathioprine compared to 5-ASA and/or placebo for the successful treatment of ulcerative colitis. These results must be interpreted with caution as they are based on two relatively small trials. Therefore, although the use of azathioprine is common in the management of UC this practice is not based on high quality evidence.
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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 | 0.062 | 0.148 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.029 |
| Bibliometrics | 0.014 | 0.011 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.007 | 0.004 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.005 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".