S1314 The Impact of Disease Status After Biologic Induction Therapy on Long-Term Outcomes in Persons With Crohn’s Disease
Bibliographic record
Abstract
Introduction: Historically, less than 20% of patients with Crohn’s disease (CD) achieve clinical remission after induction with biologic therapy. It is unknown how response to biologic induction influences disease behavior, treatment patterns, and healthcare utilization for patients maintained on biologic therapy long-term. We aimed to elucidate the impact of achieving clinical remission after biologic induction on long-term disease outcomes. Methods: We conducted a retrospective cohort study including all patients with CD who completed biologic induction at Mount Sinai Hospital, Canada before June 30, 2021. Patients were stratified by response to biologic induction as per physician global assessment as remitters (clinical remission) and non-remitters (partial or no-response). We extracted data on disease activity (symptoms, biochemistry, endoscopy, imaging), inflammatory bowel disease (IBD)-related complications, IBD-related healthcare utilization (emergency department, hospitalization, surgery), and changes to pharmacotherapy until end of follow-up. Endoscopic remission was defined as SES-CD score less than 4 or based on the endoscopist's impression. Results: Of the 160 patients included, 35.6%, 25.0%, and 28.9% had stricturing, penetrating, and perianal disease respectively, with 34.3% having a history of CD surgery. Index biologic included infliximab (24.4%), adalimumab (32.5%), vedolizumab (25.0%), and ustekinumab (11.9%). After biologic induction, 34.4% and 65.6% of patients were stratified as remitters and non-remitters respectively. Remitters were less likely to have upper gastrointestinal CD (3.6% vs 10.5%), penetrating complications (18.2% vs 28.6%), and perianal disease (16.4% vs 35.2%) at biologic start. Compared to non-remitters, remitters were more likely to be in clinical remission throughout follow-up (47.2% vs 27.6%, P =0.01) and in clinical remission at last follow-up (87.2% vs 69.5%, P =0.04). Remitters were less likely to undergo CD-related bowel resection (3.6% vs 13.3%, P =0.05) or discontinue index biologic (7.2% vs 16.1%, P =0.06). There appeared to be no significant difference in IBD hospitalizations (10.9% vs 19.0%, P =0.14) or ED visits (7.2% vs 13.3%, P =0.26). There was no difference in rates of ulcer persistence (51.6% vs 53.5%, P =0.63) or achievement of endoscopic remission (58.9% vs 48.7%, P =0.76) between remitters and non-remitters. Conclusion: Achieving clinical remission after biologic induction is associated with sustained clinical remission and reduced likelihood of subsequent CD-related bowel resection.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 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) | 0.002 | 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".