S766 Biologic Therapy in Patients With Perianal Crohn’s Disease and Association With Long-Term Rates of Surgical and Clinical Outcomes
Bibliographic record
Abstract
Introduction: Perianal Crohn’s disease (pCD) represents an aggressive phenotype with limited studies on long-term outcomes. We evaluated long-term outcomes of these patients on biologics at the time of perianal disease diagnosis and the association of type of biologic use after first anti-TNF failure. Methods: We performed a retrospective analysis of patients with pCD at a tertiary medical center through December 2020. We used Kaplan-Meier curves to estimate rates and multivariate logistic regression to identify predictors of outcomes. Results: We included 311 patients with pCD (31 patients with ulcers, 72 with fissures, 236 with abscesses, and 262 with fistulas) of which 168 patients were on biologics (138 anti-TNF, 14 vedolizumab, 16 ustekinumab) at time of perianal disease diagnosis. At 5-year follow-up, biologic use (anti-TNF, vedolizumab, or ustekinumab) at time of perianal disease diagnosis was not associated with overall rates of any surgical intervention compared to no biologics. Anti-TNF use at time of diagnosis was associated with decreased rates of perianal abscess recurrence at 5 years (HR 0.48, 95% CI 0.32-0.74), whereas ustekinumab use was associated with increased rates of perianal fistula closure (HR 3.58, 95% CI 1.04- 12.35) and decreased rates of perianal abscess recurrence (HR 0.20, 95% CI 0.07- 0.56). Among patients who failed anti-TNF, switching to another anti-TNF was associated with decreased rates of colectomy (HR 0.20, 95% CI 0.04-0.90) and permanent diversion (HR 0.16, 95% CI 0.03-0.94) compared to ustekinumab, whereas vedolizumab use was associated with decreased rates of perianal fistula closure (HR 0.22, 95% CI 0.05-0.96) compared to ustekinumab. In multivariate analysis, baseline BMI (OR 1.04, 95% CI 1.01-1.08, P = 0.037), presence of perianal abscess (OR 10.37, 95% CI 4.45-24.14, P < 0.0001), perianal fistula (OR 5.50, 95% CI 2.47-12.25, P < 0.0001), and antibiotic use (OR 2.57, 95% CI 1.31-5.07, P = 0.006) were independently associated with increased odds of any surgical intervention at 5 years. Predictors of colectomy and permanent diversion at 5 years among patients with pCD included colonic disease (Montreal L2) and anal stenosis. Conclusion: Anti-TNF and ustekinumab use at time of perianal disease diagnosis is associated with improved long-term outcomes. Among pCD patients who fail anti-TNF, switching to another anti-TNF may be more favorable to ustekinumab, whereas switching to ustekinumab may be more favorable to vedolizumab with regards to long-term outcomes.Figure 1.: Clinical Characteristics of IMDC Stratified by Treatment of the Initial IMDC Event.Table 1.: Baseline Demographics and Persistence of Tofacitinib Treatment in the OLE Study for Pts who Enrolled With a Clinical Response.
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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 | 0.003 |
| 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 | 0.001 |
| 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".