ArticlePediatrics2014
Effectiveness of anti-TNFα for Crohn disease: research in a pediatric learning health system.
Article in Pediatrics, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05689892 (Impact of a Shared Decision Making Intervention in Paediatric Inflammatory Bowel Disease Therapeutic Decision-making), which is not on this map. Cited by 20 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Impact of a Shared Decision Making Intervention in Paediatric Inflammatory Bowel Disease Therapeutic Decision-making
Who cites it
20 citing papers in PubMed.
- Effectiveness and safety of ustekinumab in pediatric Crohn's disease: Results of the REALITI study.Journal of pediatric gastroenterology and nutrition · 2026Observational
- Impact of missing patient report outcomes in clinical trials for ulcerative colitis: Should we always assume treatment failure?Crohn's & colitis 360 · 2026Article
- Exploring Physicians' Dual Perspectives on the Transition From Free Text to Structured and Standardized Documentation Practices: Interview and Participant Observational Study.JMIR formative research · 2025Observational
- Using multiple imputation of real-world data to estimate clinical remission in pediatric inflammatory bowel disease.Journal of comparative effectiveness research · 2023Article
- The SHOnet learning health system: Infrastructure for continuous learning in pediatric rehabilitation.Learning health systems · 2022Article
- Clinical Outcome Assessments in Pediatric Patients With Ulcerative Colitis and Crohn's Disease Receiving Biologics: A Retrospective Cohort Study.Crohn's & colitis 360 · 2022Article
- Clinical data for paediatric research: the Swiss approach : Proceedings of the National Symposium in Bern, Switzerland, Dec 5-6, 2019.BMC proceedings · 2021Article
- Measuring engagement in a collaborative learning health system: The case of ImproveCareNow.Learning health systems · 2021Article
- An Analysis of the Learning Health System in Its First Decade in Practice: Scoping Review.Journal of medical Internet research · 2020Article
- Robust-ODAL: Learning from heterogeneous health systems without sharing patient-level data.Pacific Symposium on Biocomputing. Pacific Symposium on Biocomputing · 2020Article
- Shared decision making in IBD: A novel approach to trial consent and timing.Contemporary clinical trials communications · 2019Article
- Shared Decision Making About Starting Anti-TNFs: A Pediatric Perspective.Journal of pediatric gastroenterology and nutrition · 2019Article
- Human Microbiome and Learning Healthcare Systems: Integrating Research and Precision Medicine for Inflammatory Bowel Disease.Omics : a journal of integrative biology · 2018Review
- Analytical Methods for a Learning Health System: 3. Analysis of Observational Studies.EGEMS (Washington, DC) · 2017Article
- Architectural frameworks: defining the structures for implementing learning health systems.Implementation science : IS · 2017Article
- Learning Health Systems as Facilitators of Precision Medicine.Clinical pharmacology and therapeutics · 2017Review
- High Levels of Decisional Conflict and Decision Regret When Making Decisions About Biologics.Journal of pediatric gastroenterology and nutrition · 2016Article
- Parents' information needs and influential factors when making decisions about TNF-α inhibitors.Pediatric rheumatology online journal · 2016Article
- Development and Refinement of a Learning Health Systems Training Program.EGEMS (Washington, DC) · 2016Article
- A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research.EGEMS (Washington, DC) · 2015Article
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Authors and funding
22 authors.
Funding
Abstract
objectivesImproveCareNow (ICN) is the largest pediatric learning health system in the nation and started as a quality improvement collaborative. To test the feasibility and validity of using ICN data for clinical research, we evaluated the effectiveness of anti-tumor necrosis factor-α (anti-TNFα) agents in the management of pediatric Crohn disease (CD).
methodsData were collected in 35 pediatric gastroenterology practices (April 2007 to March 2012) and analyzed as a sequence of nonrandomized trials. Patients who had moderate to severe CD were classified as initiators or non-initiators of anti-TNFα therapy. Among 4130 patients who had pediatric CD, 603 were new users and 1211 were receiving anti-TNFα therapy on entry into ICN.
resultsDuring a 26-week follow-up period, rate ratios obtained from Cox proportional hazards models, adjusting for patient and disease characteristics and concurrent medications, were 1.53 (95% confidence interval [CI], 1.20-1.96) for clinical remission and 1.74 (95% CI, 1.33-2.29) for corticosteroid-free remission. The rate ratio for corticosteroid-free remission was comparable to the estimate produced by the adult SONIC study, which was a randomized controlled trial on the efficacy of anti-TNFα therapy. The number needed to treat was 5.2 (95% CI, 3.4-11.1) for clinical remission and 5.0 (95% CI, 3.4-10.0) for corticosteroid-free remission.
conclusionsIn routine pediatric gastroenterology practice settings, anti-TNFα therapy was effective at achieving clinical and corticosteroid-free remission for patients who had Crohn disease. Using data from the ICN learning health system for the purpose of observational research is feasible and produces valuable new knowledge.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.