P0672 Comparative Efficacy of Medical Therapies in Reducing the Risk of Post Operative Recurrence in Crohn’s Disease (PORCD): A Systematic Review and Network Meta-analysis
Bibliographic record
Abstract
Abstract Background Up to 50% of patients with Crohn’s disease (CD) will require surgery, and 70-90% experience endoscopic recurrence within the first year postoperatively (1). Despite various treatments, there is scant data on the comparative efficacy to prevent recurrence (2). This study aims to compare the efficacy of medical treatments in preventing PORCD. Methods A comprehensive literature review was conducted using Medline, Embase, and the Cochrane Library through October 1, 2024. We included RCTs and prospective cohort studies, excluding pediatric studies, single-arm trials, and dose-comparison studies. The primary endpoint was assessing endoscopic recurrence (ER) (RS ≥i2), and secondary outcome was clinical recurrence (CDAI ≥150, Hanauer’s score ≥2, HBI ≥8) at 6, 12, and ≥18 months postoperatively. Frequentist random-effects network meta-analysis was conducted, reporting OR with 95% CI. Results A total of 42 studies were included in this meta-analysis, 38 of which were RCTs, with 2,260 patients with CD. At 6 months, ADA showed the lowest ER (SUCRA= 84.5%), followed by VDZ (74.5%). ADA significantly reduced ER compared to thiopurine (OR = 0.33 [95% CI, 0.12–0.91]), probiotics (OR = 0.17 [95% CI, 0.03–0.99]), and vitamin D (OR = 0.07 [95% CI, 0.01–0.37]). VDZ did not significantly differ from thiopurine, ADA or MDZ. At 12 months, IFX (SURCA= 93%) and ADA (SUCRA= 90%) had the lowest ER, with IFX showing significant reductions compared to thiopurine, MDZ, 5-ASA, ornidazole, and herbals (table1). Similar findings were observed at 18 months, with IFX and ADA maintaining the lowest ER rates. For clinical recurrence, no significant differences were observed among therapies at 6 months. However, at 12 months, ADA and IFX were superior to most therapies, including thiopurine, MTX, and budesonide. By 18 months, ADA had significantly less clinical recurrence than IFX (OR = 0.06 [95% CI, 0.01–0.50]). Conclusion Anti-TNFs are more effective than other therapies in preventing post-op CD recurrence. VDZ did not outperform thiopurines. Further RCTs are needed to evaluate newer therapies for post-op CD management. References 1.Spinelli A, Sacchi M, Fiorino G, Danese S, Montorsi M. Risk of postoperative recurrence and postoperative management of Crohn’s disease. World J Gastroenterol. 2011;17(27):3213-3219. doi:10.3748/wjg.v17.i27.3213 2.Fasulo E, D’Amico F, Osorio L, et al. The Management of Postoperative Recurrence in Crohn’s Disease. J Clin Med. 2023;13(1):119. Published 2023 Dec 25. doi:10.3390/jcm13010119
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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 | 0.013 | 0.026 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.021 | 0.038 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".