P510 Comparative efficacy of biologic therapies for inducing response and remission in fistulizing Crohn’s disease; Systematic Review and Network Meta-analysis
Bibliographic record
Abstract
Abstract Background The management of patients with fistulising Crohn’s disease (CD) is challenging. Several biologics have been used for the treatment of fistulising CD over the last two decades. We aimed to compare the efficacy of biologic therapies in inducing response and remission in fistulising Crohn’s disease. Methods Systematic searches were made of MEDLINE, EMBASE, Scopus, Cochrane Central databases for randomized controlled trials (RCTs) to November 2021 that assessed the efficacy of infliximab, adalimumab, certolizumab, vedolizumab, or ustekinumab against placebo or an active agent for induction of response or remission in adult Crohn’s patients with fistulising disease. Primary outcome was proportion of patients with fistula response or remission as defined by each RCT. Pairwise treatment effects were estimated through a Bayesian random-effects network meta-analysis and reported as odds ratios (OR) with a 95% confidence interval (CI). Results Ten studies were included in the analysis. Main analysis showed that there was no statistical difference in inducting remission between infliximab, adalimumab, certolizumab, vedolizumab and ustekinumab. Anti-TNFs were superior to placebo in inducing response [OR= 0.51 (95% CI 0.35; 0.750] and remission [OR= 0.36 (95% CI 0.22; 0.58)]. Infliximab was superior to placebo in inducing response [OR= 0.36 (95% CI 0.17; 0.75)] and remission [OR=0.17 (95% CI 0.03; 0.87)]. Ustekinumab was superior to placebo in inducing response [OR=0.48 (95% CI 0.26; 0.860] but not remission [OR=0.50 (95% CI 0.13; 1.93)]. Vedolizumab was not superior to placebo in inducting remission [OR=0.32 (95% CI 0.04; 2.29)]. Certolizumab was not superior to placebo in inducting response [OR=0.78 (95% CI 0.40; 1.55)] or remission [OR= 0.78 (95% CI 0.40; 1.55)]. Infliximab was superior to adalimumab in inducting response [OR=0.24 (95% CI 0.06; 0.99)] but not remission [OR=0.31 (95% CI 0.04; 2.27)]. Conclusion In patients with fistulising Crohn’s disease, anti-TNFs are effective in inducing response and remission. Infliximab was superior to adalimumab in inducing response but not remission. No difference among various biologics was observed for inducing remission. These data highlight the need for dedicated studies to assess the efficacy of biologics in fistulising Crohn’s disease.
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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 | 0.030 | 0.090 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.048 |
| Bibliometrics | 0.012 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.008 | 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".