Ustekinumab use in Crohn's disease: a Canadian tertiary care centre experience
| Autor: | Greg Rosenfeld, Astrid-Jane Greenup, Brian Bressler |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Compassionate Use Trials Male medicine.medical_specialty Canada Adolescent Drug-Related Side Effects and Adverse Reactions Disease Kaplan-Meier Estimate Logistic regression Inflammatory bowel disease Asymptomatic Tertiary Care Centers 03 medical and health sciences Young Adult 0302 clinical medicine Crohn Disease Internal medicine Ustekinumab Medicine Humans Survival analysis Retrospective Studies Crohn's disease Dose-Response Relationship Drug business.industry Tumor Necrosis Factor-alpha Remission Induction Gastroenterology Endoscopy Middle Aged medicine.disease Surgery Logistic Models 030220 oncology & carcinogenesis Multivariate Analysis 030211 gastroenterology & hepatology Observational study Female medicine.symptom business medicine.drug |
| Zdroj: | Scandinavian journal of gastroenterology. 52(12) |
| ISSN: | 1502-7708 |
| Popis: | Real world data regarding clinical response to ustekinumab in Crohn's disease is lacking. We report our experience of ustekinumab use using a novel subcutaneous (SC) induction strategy and aim to identify predictors of response.A retrospective, observational study of compassionate ustekinumab use in Crohn's disease was conducted with the use of a standard or high dose SC induction protocol. Symptomatic response was assessed after 3 months (short-term), and if remaining on therapy, within 3-12 months (medium-term) and at least 12 months (long-term). Endoscopic or radiologic response was assessed when available. Survival analysis of time to failure (cessation of ustekinumab) and multivariate logistic regression to identify predictors of response were performed.Seventy-nine patients commenced ustekinumab, with six patients lost to follow-up and five asymptomatic at baseline. Symptomatic response was assessed in 68 patients; 56% (38) of patients had a short-term symptomatic response. Type of preceding anti-TNF response was the only significant predictor of short-term response, with primary non-response being a strong predictor. In the medium-term, symptomatic response occurred in 72% (30/42) of patients and endoscopic or radiologic response was achieved in 72% (26/36) of patients assessed. The median time to failure was 22 months. Maintenance dose escalation to 90 mg every 4 weeks was successful in three of 16 patients.Fifty-six percent of patients had short-term symptomatic response, with a history of primary non-response to prior anti-TNF therapy being a predictor of response. Dose escalation had only modest benefit. |
| Databáze: | OpenAIRE |
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