S1222 Early Sonographic Transmural Remission as a Post-induction Target Across Advanced Therapies in Crohn’s Disease
Bibliographic record
Abstract
Introduction: Intestinal ultrasound (IUS) is becoming an important early target to drive treatment optimization with growing interest in clinical trials. The differential healing rates across advanced therapies (AT) remains unknown. We aimed to determine the rates of early post induction IUS transmural (TM) remission and response across AT in Crohn’s Disease (CD). Methods: Single center retrospective review of patients initiating AT who underwent IUS pre and post induction and had disease activity and biomarker data available between Aug 2020-Jan 2024. Patients with normal pre-AT IUS or post op were excluded. Primary outcome was post-induction TM response of the most affected segment (segmental response: >25% decrease in bowel wall thickness (BWT) from baseline, absolute BWT decrease >2mm, or absolute decrease >1mm with >1-point improvement in Modified Limberg Score (MLS)). Secondary outcomes were segmental and complete (all bowel segments) TM remission (BWT < 3.0mm and MLS 0). Descriptive statistics summarized data (median [IQR]), univariate analysis compared differences across groups, and binary logistic regression was used for multivariate analysis. Results: 101 patients (53% female, age 17.4 [15.0-21.1] years); disease duration 0.80 [0.17-3.96] years; post induction IUS 78 [56-102] days on AT. Segmental TM response across all AT was 63%. Segmental and complete TM remission was 36% and 35% (Figure 1). Complete TM remission was seen at a higher rate with upadacitinib (UPA) than ustekinumab (UST) (P =0.009) and risankizumab (RZB) (P =0.032) but not anti-TNF (NS). Patients with severe IUS inflammation (MLS 3) at baseline were less likely to achieve TM remission independent of AT (aOR 0.21 [0.059-0.76]). After controlling for baseline IUS severity, CRP, and individual therapies; infliximab (IFX) (aOR 11.7 [2.2-62.4]) and UPA (aOR 5.22 [1.0-27.2]) were associated with complete TM remission. Rates of segmental TM response were greater for colonic than ileal disease in UST/RZB (88% vs 47%, P =0.038), but no different in TNF/UPA. Patients started on UST/RZB after >1 failed prior AT had a trend for lower rates of TM outcomes (NS), while number of prior therapies had no impact on UPA response or remission rates. Conclusion: Post-induction TM outcomes are achievable across AT: 2/3 of patients achieve segmental TM response and 1/3 achieve complete TM remission. While TM outcomes should be used to guide therapy optimization, post-induction thresholds should be customized based on each AT and baseline IUS severity (see Table 1).Figure 1.: Post Induction Segmental Transmural Response and Remission. Table 1. - Multivariate regression of complete transmural remission [Multiple Regression, model P =0.001] aOR CI Infliximab 11.7 2.20-62.43 Adalimumab 3.85 0.93-16.0 Upadacitinib 5.22 1.002-27.23 Ustekinumab 1.38 0.21-9.15 Risankizumab 0.725 0.11-4.82 Sex, Female 2.51 0.87-7.27 Baseline BWT >5.0 0.45 0.15 Bowel Segment = Ileum 0.86 0.27-2.8 CRP (ABNORMAL) 0.44 0.14-1.38 MLS 3 (vs 0,1, or 2) 0.211 0.059-0.76 TNF Exposed 0.601 0.16-2.32 Time since Diagnosis < 2 yrs 1.68 0.41-6.81 Bio Naïve 0.89 0.106-7.46 BWT: bowel wall thickness; CRP: C-reactive protein; MLS: Modified Limberg Score.
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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 | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 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".