P0615 STEROID THERAPY IN THE AGE OF INFLIXIMAB (IFX): IMMEDIATE AND 1 YEAR OUTCOME IN NEWLY DIAGNOSED CHILDREN WITH CROHN DISEASE (CD)
Bibliographic record
Abstract
Introduction: Steroids induce CD remission within 3 months in 58% of adults, but by 1 year only 32% are steroid/surgery free (Gastro 2001;121:255). The use of IFX may have changed patients’ outcomes to steroids. PURPOSE: To determine children’s responses to steroids begun within 30 days of CD diagnosis (dx) and their need for IFX during the 1st year post-dx. Methods: Since January 2002, 18 US/Canadian sites prospectively enrolled newly diagnosed children with IBD in an observational registry. All were managed according to the dictates of their physicians, not standard protocols. The database was searched for children with CD followed for 1 yr who received po/iv steroids within 30 days after dx. Data on use of steroids, immunomodulatory agents (IA), IFX and surgery were prospectively compiled. Children were considered to have a complete response if steroids were successfully stopped by 3 months without requiring IFX or surgery. A prolonged response was defined as no steroids, IFX or surgery in the next 3 quarters (9 months). Results: 47 children (mean age 11.5 yrs, 30 male, PCDAI at dx 32+/−16) started steroids within 30 days of dx. 32 (68%) were on concomitant IA, including 20 who began IA in the 1st month. By 3 months after dx, 29 (62%) had a complete response and another 4 (9%) stopped steroid after adding IFX. Half of these responders also received IA. A prolonged response was seen in 21 (64% of initial responders, 45% of total population), but 11 required additional courses of steroids or IFX and 1 required surgery. Among the 14 subjects not off steroids by 3 months, 9 received steroids in the Quarter 2, 3 in the Quarter 3 and 2 throughout the year. Seven of the 14 were only weaned off steroids after starting IFX, and 1 failed IFX and required surgery. Overall, 16 (34%) subjects received IFX in the year and 18 (38%) required steroids (8), IFX (7) or both (3) in the 4th quarter of observation. Conclusion: 70% of children with CD receiving steroids within 30 days of dx can be weaned off steroids by 3 months, although at times only by adding IFX. While 77% of the cohort is off steroids at 1 year, 21% remain on IFX and 4% have undergone surgery despite widespread use of concomitant IA. Frequency and duration of steroid use is in large measure determined by when IFX is started. While steroid dependence can be decreased by use of IFX, studies are needed to see if IFX leads to better long term outcome in children with CD.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 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) | 0.001 | 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".