Response to Biologic Therapy in Crohnʼs Disease Does Not Differ By Race
Bibliographic record
Abstract
Purpose: While tumor necrosis factor antagonists (anti-TNF) are effective for treatment of Crohn's disease (CD), data suggests possible differences in use across racial groups. One possible reason could be differential response to and tolerance of anti-TNF agents by race. The purpose of this study was to assess for differences in response to and tolerance of anti-TNF therapy by race. Methods: All CD patients who were initiated on anti-TNF therapy and had ≥ 1 year of follow up at a tertiary care referral center between 2004 and 2008 were indentified. Demography, Montreal classification, and extraintestinal manifestations (EIM) were collected. Physician global assessment of response, adverse drug reactions, steroid use, hospitalizations and surgeries were recorded at 3, 6, and 12 months after anti-TNF initiation and compared between Caucasian (W) and non-Caucasian (NW) patients. Results: 97 patients were analyzed; 77% (77) were Caucasian (W), 20% (19) African-American and 1% (1) Hispanic (combined as NW). 63% (61) were treated with infliximab, 30% (29) with adalimumab, and 7% (7) with certolizumab. There was no difference in age, gender, smoking status, presence of EIM, or disease location between W and NW. W had more B2 and B3 behavior (47% vs. 32% and 47% vs. 37%, respectively; p=0.08), but less perianal disease (30% vs. 60%, p=0.004) than NW. W had a higher complete response rate at 3 months; however there was no difference at other time points (see table). Overall prevalence of steroid use at 3, 6, and 12 months was 29%, 16% and 16% respectively without significant differences between W and NW. The overall rate of severe adverse drug reactions at 3, 6, and 12 months was 1%, 1%, and 0% without difference by race. The mean number and prevalence of hospitalizations in each group was not different at any time point. There was a trend toward a higher prevalence of surgery in W at 12 months (17% vs. 0%, p=0.08). Conclusion: Overall response to and tolerance of anti-TNF therapy over the first 12 months appeared similar between W and NW patients when therapy was started under the care of a tertiary referral CD practice. A trend to lower response at 3 months in NW compared to W did not persist at later months, while hospitalizations and surgeries were similar between W and NW. This suggests that differences in use of anti-TNF therapy should not be justified by possible differential response by race. Disclosure: Dr Patil - none Dr Ghazi - none Mr. Rustgi - none Dr Flasar - none Dr Cross - Consultant: Abbott, Grant Funding: Centocor, Abbott.Table 1
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 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".