Re-induction With Intravenous Ustekinumab in Patients With Crohn's Disease and a Loss of Response to This Therapy
| Autor: | Fernando Bermejo, Laura Jiménez, Alicia Algaba, Milagros Vela, Guillermo Bastida, Olga Merino, Alicia López-García, Luigi Melcarne, Iago Rodríguez-Lago, Saioa de la Maza, Abdel Bouhmidi, Manuel Barreiro-de Acosta, Pilar López-Serrano, Marta Carrillo-Palau, Francisco Mesonero, Beatriz Orts, Daniel Bonillo, Alicia Granja, Iván Guerra |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Gastroenterology 03 medical and health sciences 0302 clinical medicine Refractory Crohn Disease Internal medicine Ustekinumab medicine Immunology and Allergy Humans In patient Adverse effect Crohn's disease business.industry Remission Induction Safe strategy medicine.disease Treatment efficacy Treatment Outcome Multicenter study 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Administration Intravenous business medicine.drug |
| Zdroj: | Inflammatory bowel diseases. 28(1) |
| ISSN: | 1536-4844 |
| Popis: | Background A significant percentage of patients treated with ustekinumab may lose response. Our aim was to evaluate the short-term efficacy and safety of intravenous re-induction with ustekinumab in patients with Crohn’s disease who have lost the response to the treatment. Methods This is a retrospective, observational, multicenter study. Treatment efficacy was measured at week 8 and 16; clinical remission was defined when the Harvey-Bradshaw Index was ≤4 points, and clinical response was defined as a decrease of ≥3 points in the index compared with the baseline. Adverse events and treatment decisions after re-induction were also collected. Results Fifty-three patients from 13 centers were included. Forty-nine percent had previously failed to respond to 2 biological treatments, and 24.5% had failed to respond to 3. The average exposure time to ustekinumab before re-induction was 17.7 ± 12.8 months. In 56.6% of patients, the administration interval had been shortened to every 4 to 6 weeks before re-induction. At week 8 and 16 after re-induction, 49.0% (n = 26) and 43.3% (n = 23), respectively, were in remission, whereas 64.1% (n = 34) and 52.8% (n = 28) had a clinical response. Patients who achieved remission at week 16 had lower C-reactive protein levels than those who did not respond (2.8 ± 1.6 vs 12.5 ± 9.5 mg/dL; P = 0.001). No serious adverse events related to re-induction were observed. Conclusion Intravenous re-induction with ustekinumab is an effective and safe strategy that recovers the response in approximately half of the patients with refractory Crohn’s disease who experience a loss of response. Re-induction can be attempted before switching out of the therapy class. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|