Re-induction With Intravenous Ustekinumab in Patients With Crohn's Disease and a Loss of Response to This Therapy.
Por:
Bermejo F, Jiménez L, Algaba A, Vela M, Bastida G, Merino O, López-García A, Melcarne L, Rodríguez-Lago I, de la Maza S, Bouhmidi A, Barreiro-de Acosta M, López-Serrano P, Carrillo-Palau M, Mesonero F, Orts B, Bonillo D, Granja A and Guerra I
Publicada:
5 ene 2022
Ahead of Print:
1 feb 2021
Resumen:
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.
Filiaciones:
Bermejo F:
Hospital Universitario de Fuenlabrada, Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain
Jiménez L:
Hospital Universitario de Fuenlabrada, Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain
Algaba A:
Hospital Universitario de Fuenlabrada, Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain
Vela M:
Complejo Hospitalario Universitario Ntra. Sra. de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
Bastida G:
Hospital Universitario y Politécnico La Fe, CIBEREHD, Health Research Institute La Fe, Valencia, Spain
Merino O:
Hospital Universitario de Cruces, Vizcaya, Spain
López-García A:
Hospital del Mar and Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
Melcarne L:
Hospital Universitari Parc Taulí, Sabadell, Spain
Rodríguez-Lago I:
Hospital Galdakao-Usansolo and Biocruces Bizkaia Health Research Institute, Galdakao, Vizcaya, Spain
de la Maza S:
Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
Bouhmidi A:
Hospital de Santa Bárbara, Puertollano, Cuidad Real, Spain
Barreiro-de Acosta M:
Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
López-Serrano P:
Hospital Universitario Fundacion Alcorcon, Madrid, Spain
Carrillo-Palau M:
Hospital Universitario de Canarias, Tenerife, Spain
Mesonero F:
Hospital Universitario Ramón y Cajal, Madrid, Spain
:
Hospital General Universitario de Alicante, Alicante, Spain
Bonillo D:
Hospital Universitario de Fuenlabrada, Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain
Granja A:
Hospital Universitario de Fuenlabrada, Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain
Guerra I:
Hospital Universitario de Fuenlabrada, Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain
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