A nationwide real-world study on dynamic ustekinumab dosing and concomitant medication use among Crohn's disease patients in Finland
Autor: | Jyrki Tillonen, Ritva Koskela, M Koivunen, Ulla Maija Suhonen, Mikko Heikura, Christian Nielsen, Anja Eberl, Taru Hallinen, E Christina M Wennerström, Mikko Kellokumpu, Heikki Nuutinen, Markku Heikkinen, Erkki Soini, Tuire Ilus, Andras Borsi, Clas Göran af Björkesten, Taina Sipponen |
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Přispěvatelé: | HUS Abdominal Center, Gastroenterologian yksikkö, University of Helsinki, Helsinki University Hospital Area, HYKS erva, Päijät-Häme Welfare Consortium, Tampere University, Department of Gastroenterology, Department of Internal medicine |
Rok vydání: | 2021 |
Předmět: |
Adult
medicine.medical_specialty ustekinumab antibodies Disease Biologicals 3121 Internal medicine Inflammatory bowel disease ustekinumab 03 medical and health sciences 0302 clinical medicine Refractory Crohn Disease inflammatory bowel disease Adrenal Cortex Hormones Internal medicine Ustekinumab medicine trough level Humans Dosing Finland Retrospective Studies Crohn's disease business.industry Remission Induction Gastroenterology 3126 Surgery anesthesiology intensive care radiology medicine.disease humanities dosing 3. Good health Treatment Outcome 030220 oncology & carcinogenesis Concomitant 3121 General medicine internal medicine and other clinical medicine Trough level 030211 gastroenterology & hepatology business medicine.drug |
Zdroj: | Scandinavian journal of gastroenterology. 56(6) |
ISSN: | 1502-7708 |
Popis: | Background: Real-world evidence to support optimal ustekinumab dosing for refractory Crohn’s disease (CD) patients remains limited. Data from a retrospective nationwide chart review study was utilized to explore ustekinumab dosing dynamics and optimization, identify possible clinical predictors of dose intensification, and to evaluate ustekinumab trough concentrations (TCs) and concomitant medication use in Finland. Methods: Information gathered from17 Finnish hospitals included clinical chart data from 155 adult CD patients who received intravenous ustekinumab induction during 2017–2018. Data on ustekinumab dosing and TCs, concomitant corticosteroid and immunosuppressant use, and antiustekinumab antibodies were analyzed in a two-year follow-up, subject to availability. Results: Among 140 patients onustekinumab maintenance therapy, dose optimization was required in 55(39%) of the patients, and 41/47 dose-intensified patients (87%) persisted on ustekinumab. At baseline, dose-intensified patient group had significantly higher C-reactive protein (CRP) levels, and at week 16, significantly lower ustekinumab TCs than in patients without dose intensification. Irrespective of dose optimization, a statistically significant reduction in the use of corticosteroids was observed at both 16 weeks and one year, coupled with an increased proportion of patients on ustekinumab monotherapy. Antiustekinumab antibodies were undetectable in all 28 samples from 25 patients collected throughout the study period. Conclusions: Nearly a third of all CD patients on ustekinumab maintenance therapy, with a history of treatment-refractory and long-standing disease, required dose intensification. These patients persisted on ustekinumab and had significant reduction of corticosteroid use. Increased baseline CRP was identified as the sole indicator of dose intensification. Trial registration: EUPAS30920. publishedVersion |
Databáze: | OpenAIRE |
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