Effectiveness and safety of ustekinumab dose escalation in Crohn's disease: a multicenter observational study.

Autor:	Olmedo Martín RV; UGC Aparato Digestivo, Hospital Regional Universitario Málaga, España., Vázquez Morón JM; Aparato Digestivo, Hospital Universitario Juan Ramón Jiménez., Martín Rodríguez MDM; Aparato Digestivo, Hospital Universitario Virgen de las Nieves., Lázaro Sáez M; Aparato Digestivo, Hospital Universitario Torrecárdenas., Hernández Martínez Á; Aparato Digestivo, Hospital Universitario Torrecárdenas, España., Argüelles-Arias F; UGC Aparato Digestivo, Hospital Universitario Virgen Macarena, Spain.
Jazyk:	angličtina
Zdroj:	Revista espanola de enfermedades digestivas [Rev Esp Enferm Dig] 2023 Dec; Vol. 115 (12), pp. 686-692.
DOI:	10.17235/reed.2023.9402/2022
Abstrakt:	Background: ustekinumab has proven effective in Crohn's disease (CD). However, some patients will partially respond or lose response over time. Data supporting the effectiveness of dose escalation in this scenario is scarce. Aim: to evaluate the effectiveness of ustekinumab dose escalation in CD. Methods: patients with active CD (Harvey-Bradshaw ≥ 5) who had received intravenous (IV) induction and at least a subcutaneous (SC) dose were included in this retrospective observational study. Ustekinumab dose was escalated, either via shortening of the interval to six or four weeks or IV reinduction plus shortening to every four weeks. Results: ninety-one patients were included, and ustekinumab dose was escalated after a median of 35 weeks of treatment. At week 16 after intensification, steroid-free clinical response and remission were observed in 62.6 % and 25.3 % of patients, respectively. Systemic corticosteroids were discontinued in 46.7 % of patients who were on corticosteroids at baseline. Follow-up data beyond week 16 were available for 78 % of patients; at the last visit, 66.2 % and 43.7 % were in steroid-free clinical response and remission, respectively. After a median follow-up of 64 weeks, 81 % of patients were still treated with ustekinumab. Adverse events were reported in 4.3 % of patients; these were all mild and did not lead to hospitalization or discontinuation of treatment. Five patients (5.5 %) underwent surgical resection, with no immediate postsurgical complications. Conclusion: ustekinumab dose escalation was effective in recapturing response in over half of the patients. These findings suggest that dose escalation should be considered in patients who experience loss or partial response to the standard maintenance.
Databáze:	MEDLINE
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