P467. Systematic Review and Meta-Analysis: Infliximab or Ciclosporin as Rescue Therapy in Patients with Severe Ulcerative Colitis Refractory to Steroids
Bibliographic record
Abstract
Background: Acute severe steroid-refractory ulcerative colitis (UC) carries a poor prognosis and requires optimal management. A systematic review and meta-analysis were conducted to assess ciclosporin and infliximab (IFX) as rescue agents in patients with steroid refractory UC. Methods: A literature search identified studies that investigated IFX and ciclosporin in steroid-refractory ulcerative colitis patients. The primary outcome was short term response to treatment. Secondary outcomes included the rates of colectomy at 3 months and 12 months, adverse drug reactions, postoperative complications in those who received rescue therapy but underwent colectomy subsequently, and mortality. Odds ratios (OR) with 95% confidence intervals (CI) are reported. Results: Overall, eleven studies with 988 participants were eligible for inclusion. Among two randomized controlled trials with 145 patients, no significant difference was seen with IFX compared to ciclosporin with regards to treatment response, and 3-month or 12-month colectomy. Among non-randomized studies with 843 eligible participants, IFX was associated with significantly higher rates of treatment response (OR 2.99 (95% CI 2.99-4.30)) and lower 12-month colectomy rate (OR 0.38 (95% CI, 0.17-0.85)), with no significant difference seen in 3 month colectomy rate (OR 0.71 (95% CI, 0.26-1.89) compared to ciclosporin. There was no significant difference between IFX and ciclosporin in adverse drug-related events, postoperative complications, or mortality. Conclusions: In the management of steroid refractory severe UC, no definitive preference between IFX and ciclosporin exists based on randomized trials, but non-randomized studies suggest IFX is associated with better treatment response and lower risk of colectomy at 12 months.
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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 | 0.010 | 0.031 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.031 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 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".