Comparative Improvement in Health-Related Quality of Life With Advanced Therapies for Moderate-to-Severe Crohn's Disease: A Network Meta-Analysis
Bibliographic record
Abstract
INTRODUCTION: The comparative efficacy of advanced therapies to improve health-related quality of life (HR-QoL) in Crohn's disease (CD) is unknown. We aimed to compare the impact of approved advanced therapies for moderate-to-severe CD on HR-QoL. METHODS: We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to December 2023. We included randomized controlled trials that assessed approved advanced therapies for the treatment of adults with moderate-to-severe luminal CD. The primary outcome was change from baseline in the Inflammatory Bowel Disease Questionnaire (IBDQ). Pairwise random-effects meta-analyses were conducted, and we reported results as mean differences (MDs) for continuous outcomes and risk ratios for binary outcomes, with corresponding 95% confidence intervals (CIs). A random-effects frequentist network meta-analysis was conducted, and the competing interventions were ranked using the P-score. RESULTS: Our search strategy included 34 records that fulfilled our eligibility criteria. In pairwise meta-analysis, advanced therapies were associated with improvements in IBDQ score (MD 16.07, 95% CI 12.59-19.54) after induction. In network meta-analysis, upadacitinib 45 mg ranked first for change in IBDQ after induction (MD 23.10, 95% CI 14.41-31.78, P-score 0.86). For maintenance studies, advanced therapies showed a significant improvement in IBDQ score in pairwise meta-analysis (MD 12.72, 95% CI 10.47-14.97). Infliximab 10 mg/kg ranked first for change in IBDQ after maintenance (MD 24.91, 95% CI 12.99-36.83, P-score 0.90). DISCUSSION: Advanced therapies were associated with improvements in HR-QoL after induction and maintenance. Upadacitinib 45 mg and infliximab 10 mg/kg ranked highest after induction and maintenance, respectively.
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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 | 0.038 | 0.064 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.024 | 0.053 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".