PROSPECTIVE IMPLEMENTATION OF T2T STRATEGIES IN ADOLESCENTS AND YOUNG ADULTS WITH CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS LED TO IMPROVED DISEASE CONTROL AND MINIMIZED DAMAGE ACCRUAL
Bibliographic record
Abstract
PV160 / #31 Poster Topic: AS18 - Pediatric SLE Background/Purpose Treat-to-target (T2T) strategies aim to facilitate tight disease control. No previous studies evaluated prospectively the feasibility and impact of active implementation of T2T strategy at every routine clinical appointment in adolescents and young adults (AYA) with childhood-onset SLE (cSLE). Methods AYA with cSLE were recruited for T2T implementation from a large tertiary center over a period of 6 months, and followed up at least twice over a prospective period of 12 months. The study had the following design: 1. The first phase of the study was a 6-month cross-sectional evaluation of the feasibility to implement and systematically document routine outcome measures in AYA with cSLE. At the end of this phase, only AYA with cSLE and complete data collection including disease activity evaluation as well as treatment target assessment and documentation, were included. 2. The second phase of the study was a 12-month prospective evaluation of disease control against the agreed cSLE target between the baseline assessment and the final timepoint (last routine clinic appointment during the 12-month study follow-up period). In support of our project design robustness, a preliminary sample size calculation was undertaken, which showed that we needed to include at least 115 individuals to be able to detect with 90% confidence and 80% power, a 10% improvement in the proportion of AYA with cSLE achieving LLDAS after 12 months of active T2T strategy implementation. Results During Oct 2022-April 2023, 135/162 (83.3%) AYA with cSLE had disease scores evaluated at their routine appointment to enable inclusion in the study and 122/135 (91.2%) had their disease assessed, and a suitable treatment target agreed and documented at each routine clinical appointment over the following 12 months. T2T strategy led to improved disease: more AYA with cSLE achieved clinical remission off steroids (4.1% vs. 10.7%, P=0.048), or minimum childhood-lupus low disease activity (cLLDAS) (81.9% vs. 91.8%, P=0.022) (Table). Achieving minimum cLLDAS for longer than 3 months was associated with reduced damage accrual (HR=1.7; 95% CI=1.1-2.5; P<0.0001) and a trend in flare risk improvement (HR=1.6, 95% CI=0.98-1.4; P=0.06) after 12 months. We found a positive correlation between the damage (pedSDI) score and cumulative steroid dose (median dose = 615 mg) over the 12-month prospective evaluation (ro=0.37, p=0.04). Table: Assessment of disease states at the timepoint of agreeing a treatment target (baseline) and after 12 months routine follow-up Conclusions This is the first large prospective study in AYA with cSLE which showed that T2T strategy implementation was achievable in routine practice and led to an improved proportion of AYA ‘in target’. Spending at least 3/12 months in cLLDAS led to less damage accumulation over 12-month follow-up.
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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 | 0.006 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| 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".