Ustekinumab is more effective than azathioprine to prevent endoscopic postoperative recurrence in Crohn's disease

Autor: Buisson, Anthony, Nancey, Stéphane, Manlay, Luc, Rubin, David, Hebuterne, Xavier, Pariente, Benjamin, Fumery, Mathurin, Laharie, David, Roblin, Xavier, Bommelaer, Gilles, Pereira, Bruno, Peyrin‐biroulet, Laurent, Vuitton, Lucine, Post-Op Study Grp, Ustek
Přispěvatelé: Service d'Hépatologie Gastro-entérologie [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Clermont Auvergne (UCA), Service d'Hépatogastroentérologie [CHU Lyon-Sud], Hospices Civils de Lyon (HCL), The University of Chicago Medicine [Chicago], Servcie Hépato-gastroentérolgie et Nutrition clinique [CHU Nice], Centre Hospitalier Universitaire de Nice (CHU Nice), Service Gastro-entérologie adulte – Maladies de l’appareil digestif [CHU Lille], CHU Lille, Service d'Hépato Gastroenterologie [CHU Amiens-Picardie], CHU Amiens-Picardie, Périnatalité et Risques Toxiques - UMR INERIS_I 1 (PERITOX), Institut National de l'Environnement Industriel et des Risques (INERIS)-Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Service Gastroentérologie [CHU Bordeaux], Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux), Service de Gastro-entérologie et Hépatologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Unité de Biostatistiques [CHU Clermont-Ferrand], Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), Service d'Hépato-gastro-entérologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Gastro-Entérologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), 'Francois Aupetit' Association (AFA CrohnRCH), CHU Clermont-Ferrand (DRCI), Centre Hospitalier Universitaire de Lille (CHU Lille), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie-Institut National de l'Environnement Industriel et des Risques, Service de gastroentérologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne)
Rok vydání: 2021
Předmět:
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Azathioprine
Antibodies
Monoclonal
Humanized
Gastroenterology
ustekinumab
law.invention
03 medical and health sciences
0302 clinical medicine
Crohn Disease
Gastrointestinal Agents
Randomized controlled trial
Recurrence
law
Internal medicine
Ustekinumab
Secondary Prevention
medicine
Clinical endpoint
Humans
postoperative recurrence
Propensity Score
Retrospective Studies
Crohn's disease
azathioprine
business.industry
Inflammatory Bowel Disease
[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
Bowel resection
medicine.disease
Control Groups
3. Good health
Oncology
030220 oncology & carcinogenesis
Cohort
Propensity score matching
Original Article
Female
030211 gastroenterology & hepatology
business
Immunosuppressive Agents
medicine.drug
Zdroj: United European Gastroenterology Journal
United European Gastroenterology Journal, 2021, 9 (5), pp.552-560. ⟨10.1002/ueg2.12068⟩
United European Gastroenterology Journal, SAGE Publications, 2021, 9 (5), pp.552-560. ⟨10.1002/ueg2.12068⟩
ISSN: 2050-6414
2050-6406
Popis: International audience; Background: Preventing postoperative recurrence (POR) is a major concern in Crohn's disease (CD). While azathioprine is an option, no data is available on ustekinumab efficacy in this situation.Aims: We compared the effectiveness of ustekinumab versus azathioprine in preventing endoscopic POR in CD.Methods: We retrospectively collected data from all consecutive CD patients treated with ustekinumab after intestinal resection in 9 centers. The control group (azathioprine alone) was composed of patients who participated in a randomized controlled trial conducted in the same centers comparing azathioprine alone or in combination with curcumin. Propensity score analyses (inversed probability of treatment weighting = IPTW) were applied to compare the two groups. The primary endpoint was endoscopic POR (Rutgeerts' index ≥ i2) at 6 months.Results: Overall, 32 patients were included in the ustekinumab group and 31 in the azathioprine group. The propensity score analysis was adjusted on the main risk factors (smoking, fistulizing phenotype, prior bowel resection, resection length >30 cm and ≥2 biologics before surgery) and thiopurines or ustekinumab exposure prior to surgery making the two arms comparable (∣d∣ < 0.2). After IPTW, the rate of endoscopic POR at 6 months was lower in patients treated with ustekinumab compared to azathioprine (28.0% vs. 54.5%, p = 0.029). After IPTW, the rates of i2b-endoscopic POR (Rutgeerts' index ≥ i2b) and severe endoscopic POR (Rutgeerts' index ≥ i3) were 20.8% versus 42.5% (p = 0.066) and 16.9% versus 27.9% (p = 0.24), in the ustekinumab and azathioprine groups, respectively.Conclusion: Ustekinumab seemed to be more effective than azathioprine in preventing POR in this cohort of CD patients.
Databáze: OpenAIRE
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