A219 TRENDS IN TNF-ALPHA INHIBITOR UTILIZATION IN CHILDREN WITH IBD DURING THE LAST 10 YEARS: 2009–2018
Bibliographic record
Abstract
Since the last decade, anti-TNF have been increasingly used in the treatment of inflammatory bowel diseases (IBD), but the pattern of use is still not completely defined, especially in the pediatric population. We aimed to define the pattern of use of these monoclonal antibodies and the associated factors during the past ten years. We conducted a cross-sectional analysis of consecutive children with IBD (Crohn’s disease (CD), ulcerative colitis (UC) or unclassified colitis (IBDU)) at CHU Sainte-Justine who had received a treatment with an anti-TNF (Infliximab (IFX) or Adalimumab (ADA)) between January 2009 and October 2018. The primary outcome was the time between IBD diagnosis and the initiation of TNF-alpha inhibitor over the years. The secondary outcomes were the proportion of patients receiving that treatment within three months of diagnosis (early treatment), and the factors associated with early initiation (< 3 months after IBD diagnosis). Among the 925 patients diagnosed between January 2009 and October 2018, [(median (IQR) age at diagnosis 13.9 (4.5) years; 49% female; CD (n=622), UC (n=174), IBDU (n=129)], a total of 509 (55.0%) were exposed to anti-TNF. The median (IQR) PCDAI at diagnosis was 32.5 (20.0) for CD, and the median (IQR) PUCAI was 50.0 (35.0) in UC/IBDU. The median (IQR) age at start of anti-TNF was 14.1(4.5) years. The first exposition to anti-TNF was IFX (n=373), or ADA (n=46). Overall, the median (IQR) interval between IBD diagnosis and the initiation of TNF-alpha inhibitor was 117 (346) days. The median (IQR) interval was 354.0 (940.0) days for patients diagnosed in 2009–2010 and declined to reach 26.0 (101.0) days in 2017–2018. The rate of early treatment (<90 days) was 4.8% in 2009 and gradually increased to reach a maximum of 42.9% in 2018 (Table 1). In the cohort as a whole, the proportion of early treatment with anti-TNF was higher for CD (27.0%) and UC (31.0) than IBDU (6.9%), P<0.0001. A younger age at diagnosis was associated with an earlier start of anti-TNF (Hazard ratio = 1.40 (95% CI = 1.13–1.74); P= 0.0024). (Figure1) More than 50% of children are exposed to anti-TNF after a median follow-up of 4.1 years. Over the last few years, anti-TNF, are being used earlier in the course of IBD in children. A long-term follow-up of this cohort would be useful to assess whether the early anti-TNF approach impacts the long-term durability of remission and the long-term probability to remain under these drugs. Table 1: Change in Early Administration of Anti-TNF (Within 6 Months of IBD Diagnosis) During the Period 2009–2018 None
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".