Bibliographic record
Abstract
Sir, I would like to thank Dr Berden for his response to my editorial ‘How did cyclophosphamide become the drug of choice for lupus nephritis?’ [1]. As I emphasized in the paper, the editorial did not purport to provide an in-depth review of every study of immunosuppression in lupus nephritis. In particular, I chose not to discuss the study by Grootscholten et al. [2] because of the unbalanced treatment protocol that compared pulsed intravenous cyclophosphamide combined with daily oral prednisone with azathioprine in combination with pulse methylprednisolone. In addition, because the results were reported as relative risks, it was difficult to interpret the outcomes in this cohort of 87 patients. Although Dr Berden says in this letter that ‘non-sustained doubling of serum creatinine occurred more frequently in the AZA groups (RR 5.2; 95% CI 1.1–25.2; P = 0.04)’, in the actual publication it reports: ‘The proportion of patients that reached the primary end point (non-sustained doubling of initial serum creatinine) did not differ significantly between the two arms’ [2]. To clarify, it is only in the follow-up renal biopsy study [3] of less than half of the original cohort, published in a rheumatology journal [4], that nine patients reached the end-point of sustained or non-sustained doubling of serum creatinine, and this outcome was more frequent in the azathioprine-treated group. The median chronicity index did increase more in this group, but, as the authors noted, none of the examined pathological variables predicted long-term renal function [3]. Unfortunately, the data in the two studies by Grootscholten et al. are not sufficient to support Dr Berden's conclusion that ‘azathioprine is not the first drug of choice for induction treatment in patients with lupus nephritis’. Rather than trying to make a generalized statement about therapy to fit all patients, my editorial is a plea to remember that there exists a choice in treatment, with insufficient evidence to promote one therapy or another as the ‘gold standard’. Conflict of interest statement. None declared.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.005 | 0.047 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.006 | 0.004 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.046 | 0.044 |
| Insufficient payload (model declined to judge) | 0.021 | 0.016 |
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".