Ustekinumab is effective for perianal fistulising Crohn's disease: a real-world experience and systematic review with meta-analysis.

Autor:	Godoy Brewer GM; Department of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, Maryland, USA., Salem G; Department of Gastroenterology, Oklahoma University Medical Center, Oklahoma City, Oklahoma, USA., Afzal MA; Department of Internal Medicine, St Joseph's University Medical Center, Paterson, New Jersey, USA., Limketkai BN; Department of Gastroenterology, University of California Los Angeles, Los Angeles, California, USA., Haq Z; Department of Internal Medicine, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA., Tajamal M; Rawalpindi Medical College, Rawalpindi, Pakistan., Melia J; Department of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, Maryland, USA., Lazarev M; Department of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, Maryland, USA., Selaru FM; Department of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, Maryland, USA., Parian AM; Department of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, Maryland, USA aparian1@jhmi.edu.
Jazyk:	angličtina
Zdroj:	BMJ open gastroenterology [BMJ Open Gastroenterol] 2021 Dec; Vol. 8 (1).
DOI:	10.1136/bmjgast-2021-000702
Abstrakt:	Background: Perianal Crohn's disease (pCD) is a debilitating complication affecting up to 30% of Crohn's disease (CD) population, leading to increased morbidity, mortality and decreased quality of life. Despite the growing armamentarium of medications for luminal CD, their efficacy in pCD remains poorly studied. Aim: To determine the efficacy of ustekinumab, a biologic approved for luminal CD, in pCD through a retrospective cohort study and systematic review. Methods: A retrospective cohort study on patients with CD with active perianal fistulae treated with ustekinumab from September 2013 to August 2019 was performed to determine perianal fistula response and remission at 6 and 12 months after ustekinumab induction. A systematic review was performed to further establish rates of fistula response and remission with ustekinumab. Results: At 6 months, 48.1% (13/27) patients achieved fistula response with none achieving fistula remission on provider exam, and 59.3% (16/27) achieved patient-reported symptomatic improvement with 3.7% (1/27) achieving symptomatic remission. At 1 year, on provider exam, 55.6% (5/9) had fistula response with none achieving fistula remission, and 100% (9/9) had symptomatic improvement with 22.2% (2/9) achieving symptomatic remission. There were no major safety signals during 1-year follow-up. The systematic review of 25 studies found 44% (92/209) of patients with active perianal fistulas had a clinical response within 6 months of follow-up, and 53.9% (85/152) of patients with 12 months of follow-up achieved clinical response. Conclusion: Ustekinumab presents a safe and effective therapy for treatment of pCD. Prospective, randomised trials are needed to further elucidate long-term efficacy of ustekinumab for pCD. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu