Biologic Therapies for the Treatment of Post Ileal Pouch Anal Anastomosis Surgery Chronic Inflammatory Disorders: Systematic Review and Meta-analysis
Bibliographic record
Abstract
Abstract Background Chronic inflammatory disorders after ileal pouch-anal anastomosis (IPAA) surgery are common. These include chronic pouchitis, Crohn’s disease of the pouch, prepouch ileitis, and rectal cuff inflammation. The aim of this study was to evaluate the efficacy of biologic therapies in treating these disorders. Method Systematic review of all published studies from inception to April 1st, 2021 was performed to investigate the efficacy of biologic therapies for post IPAA chronic inflammatory disorders. The primary outcome was the efficacy of biologic therapies in achieving complete response or remission. A subgroup analysis was performed for each disorder separately. Results A total of 24 studies were identified including 682 patients. Using a random effect model, the overall pooled efficacy of biologic therapies in achieving complete response or remission in patients with post IPAA surgery chronic inflammatory disorders was 60% (95% Confidence Interval (CI), 56 - 64). Specifically, the pooled efficacy of ustekinumab was 75% (95% CI, 64 - 85, p = 0.007), whereas the efficacy of vedolizumab was 60% (95% CI, 52 - 68, p = 0.172). In addition, the efficacy infliximab and adalimumab were 59% (95% CI, 53 - 64, p <0.01) and 51% (95% CI, 42 - 60, p = 0.452) respectively. Conclusion Ustekinumab, infliximab, vedolizumab and adalimumab are effective in achieving complete response or remission in post IPAA surgery chronic inflammatory disorders. There is also a clear trend toward higher efficacy in patients with Crohn’s disease of the pouch compared to chronic pouchitis. More studies are needed to determine the efficacy of biologics in cuffitis. Summary Chronic inflammatory disorders after ileal pouch-anal anastomosis surgery are common. These include chronic pouchitis, Crohn’s disease of the pouch, prepouch ileitis, and rectal cuff inflammation. This study aimed to evaluate the efficacy of biologic therapies in achieving complete response or remission in these disorders.
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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 | 0.009 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.027 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".