1. Effectiveness of ustekinumab dose escalation in Crohn's disease patients with insufficient response to standard-dose subcutaneous maintenance therapy
- Author
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Kopylov, U., Hanzel, J., Liefferinckx, C., Marco, D. De, Imperatore, N., Plevris, N., Baston-Rey, I., Harris, R.J., Truyens, M., Domislovic, V., Vavricka, S., Biemans, V.B.C., Myers, S., Sebastian, S., Ben-Horin, S., Lama, Y. González, Gilletta, C., Ariella, B.S., Zelinkova, Z., Weisshof, R., Storan, D., Zittan, E., Farkas, K., Molnar, T., Franchimont, D., Cremer, A., Afif, W., Castiglione, F., Lees, C., Acosta, M. Barreiro-de, Lobaton, T., Doherty, G., Krznaric, Z., Pierik, M., Hoentjen, F., Drobne, D., Kopylov, U., Hanzel, J., Liefferinckx, C., Marco, D. De, Imperatore, N., Plevris, N., Baston-Rey, I., Harris, R.J., Truyens, M., Domislovic, V., Vavricka, S., Biemans, V.B.C., Myers, S., Sebastian, S., Ben-Horin, S., Lama, Y. González, Gilletta, C., Ariella, B.S., Zelinkova, Z., Weisshof, R., Storan, D., Zittan, E., Farkas, K., Molnar, T., Franchimont, D., Cremer, A., Afif, W., Castiglione, F., Lees, C., Acosta, M. Barreiro-de, Lobaton, T., Doherty, G., Krznaric, Z., Pierik, M., Hoentjen, F., and Drobne, D.
- Abstract
Contains fulltext : 220068.pdf (Publisher’s version ) (Closed access), BACKGROUND: Ustekinumab is effective in Crohn's disease. However, a substantial proportion of patients will not respond or lose response to ustekinumab. The current evidence to support the effectiveness of dose-optimisation for ustekinumab nonresponse is limited. AIM: To assess the effectiveness of dose escalation of ustekinumab. METHODS: This was a multicentre retrospective cohort study. We included active Crohn's disease patients who received a standard-dose intravenous induction and at least one subcutaneous ustekinumab 90 mg dose. All enrolled patients received dose escalation by either shortening the interval between the doses to every 4 or 6 weeks, intravenous reinduction or a combination of strategies. The primary outcome of the study was clinical response at week 16 after dose escalation. RESULTS: A total of 142 patients (22 centres/14 countries) were included. The patients were dose-escalated after a median treatment duration of 30 weeks. At week 16 from escalation, 73/142 (51.4%) responded to treatment, including 55/142 (38.7%) in clinical remission. Corticosteroid-free remission was achieved in 6/34 (17.6%) patients on corticosteroids at the time of escalation; 118/142 (83%) continued treatment beyond week 16. Follow-up data beyond week 16 were available for 74/118 (62.7%) patients. On the last follow-up, 51/98 (52%) patients with available data responded to treatment, including 41/98 (42%) in clinical remission. CONCLUSIONS: Intensification of ustekinumab maintenance dosage was effective in over 50% of the patients. This strategy should be considered in patients who are nonresponsive to every 8 weeks ustekinumab maintenance dosing.
- Published
- 2020