P104 Frequent disease relapse after withdrawal of infliximab in IBD patient with sustained remission
Bibliographic record
Abstract
Introduction In the UK, NICE guidance recommends annual review of biologics, with withdrawal of therapy in all patients in remission. This study retrospectively evaluates disease course following withdrawal of infliximab in IBD patients with sustained remission. Primary Outcome Relapse free survival. Secondary Outcomes Identification of predictors of relapse and evaluation of response to future therapy. Methods IBD patients from Royal London Hospital who ceased infliximab due to sustained remission were identified. The following information was obtained from electronic patient records: demographics, Montreal classification, immunomodulator use, clinician determined relapse, objective evaluation of disease activity within 3 months prior to treatment cessation and 6/12/18/24 months following cessation (CRP>5, calprotectin>50, endoscopic, radiological), steroid use at relapse, subsequent biologic use and outcome Analysis was undertaken for total IBD, CD and UC. Survival analysis and logistical regression was calculated using SPSS®. Results 75 patients were identified. CD:UC = 43:32. F:M = 34:41, median age = 31.3 years (IQR 41.15–40.75), median duration of follow up = 21.1 months (IQR 11.1–44.2), Asian:Black:Caucasian:Unknown = 16:3:47:9. The median relapse free survival for CD was 12.4 months (IQR 10.4–14.4) and for UC was 18.2 months (IQR 10.5–25.9). Relapse rates for patients who had completed follow up for each time point are presented in table 1: In univariate analysis, perianal disease and L3 disease were negatively associated with relapse at 1 year for patients with CD (perianal OR 0.87 CI 0.09–0.81 p=0.03 and L3 OR 0.18 (comparator L1) CI 0.04–0.87 p=0.03). However significance was lost when multivariate analysis was undertaken. Following relapse, 43.1% (19/44) required steroids and 88.6% (39/44) restarted a biologic, 69.2% (30/44) restarting infliximab. Of those who restarted infliximab, 56.7% (17/30) responded to standard therapy, with 10% (3/30) requiring dose escalation. 33.3% (10/30) required alternative therapy. Conclusion Within 24 months of cessation 76.5% patients relapsed. The majority of these restarted a biologic. However, only 56.7% patients who restarted infliximab responded to standard dose. With additional costs of newer biologics and morbidity of disease flare and steroid use, routine withdrawal of TNF antagonists should only occur after careful consideration.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| 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) | 0.004 | 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".