Intravenous ustekinumab reinduction as a Crohn�s disease rescue strategy following a secondary non-response

Morón, Juan María Vázquez; Moncada, Rafael Rodríguez; Manrique, Héctor Pallarés

doi:10.17235/reed.2019.5802/2018

Cited by 5 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ustekinumab’s weight‐based (6mg/kg) intravenous loading followed by 90mg subcutaneous maintenance dosing, makes re‐induction an attractive strategy to address nonresponse; with the clinical effectiveness of this strategy supported by case series. 7‐9 In this study, a higher proportion of patients undergoing combination ustekinumab re‐induction and 4‐weekly dose interval shortening achieved week 16 clinical response (10/16, 62.5%) than any other strategy. There were also higher rates of week 16 clinical response in the combination re‐induction and 4‐weekly dose interval shortening group relative to re‐induction alone (5/14, 35.7%).…”

mentioning

confidence: 66%

Letter: ustekinumab dose intensification for loss of response—should we re‐induce before shortening the dose interval?

Srinivasan

Cruz

Langenberg

2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 66%

Letter: ustekinumab dose intensification for loss of response—should we re‐induce before shortening the dose interval?

Srinivasan

Cruz

Langenberg

2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…12,16 In addition to interval shortening, a strategy of intravenous reinduction is utilised in some centres; however, the evidence to support it is minimal to date. 28 Our study has some limitations. Primarily, this was a multicentre retrospective study that shares common limitations with similar efforts, namely heterogeneity in treatment strategies, lack of predefined timing of visits and missing biological data.…”

Section: Discussionmentioning

confidence: 89%

“…The effectiveness of further dose escalation in patients who did not respond to q8w dosing has not been reported so far, with the exception of the GETAID experience reported as an abstract (57% response in 69 patients after a median of 2.1 months) 21 and a very limited number of patients in early real‐world series 12,16 . In addition to interval shortening, a strategy of intravenous reinduction is utilised in some centres; however, the evidence to support it is minimal to date 28 …”

Section: Discussionmentioning

confidence: 99%

Effectiveness of ustekinumab dose escalation in Crohn’s disease patients with insufficient response to standard‐dose subcutaneous maintenance therapy

Kopylov¹,

Hanžel²,

Liefferinckx³

et al. 2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Summary 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.

show abstract

“…Of these, IV re-induction was performed in 7 cases, and the treatment was effective in 4 (57.1%) patients. 11 Other small series, which include fewer than 10 patients with a previous failure to respond to biological drugs, also describe good results in the clinical response, 12,13 along with positive endoscopic and histological findings. 12 In a retrospective cohort study at 2 Canadian centers, re-induction due to a secondary loss of response was performed in 16 patients.…”

Section: Discussionmentioning

confidence: 96%

“…Published data on the efficacy of IV re-induction with UST in patients with Crohn's disease who have lost the response obtained with this therapy are very scarce, and these series include a limited number of patients. [11][12][13][14][15][16][17] In a multicenter, retrospective cohort of patients responding to UST, one third of them (n = 35) lost response. Of these, IV re-induction was performed in 7 cases, and the treatment was effective in 4 (57.1%) patients.…”

Section: Discussionmentioning

confidence: 99%

Re-induction With Intravenous Ustekinumab in Patients With Crohn’s Disease and a Loss of Response to This Therapy

Bermejo

Jiménez

Algaba

et al. 2021

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

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.

show abstract

Intravenous ustekinumab reinduction as a Crohn�s disease rescue strategy following a secondary non-response

Cited by 5 publications

References 5 publications

Letter: ustekinumab dose intensification for loss of response—should we re‐induce before shortening the dose interval?

Letter: ustekinumab dose intensification for loss of response—should we re‐induce before shortening the dose interval?

Effectiveness of ustekinumab dose escalation in Crohn’s disease patients with insufficient response to standard‐dose subcutaneous maintenance therapy

Re-induction With Intravenous Ustekinumab in Patients With Crohn’s Disease and a Loss of Response to This Therapy

Contact Info

Product

Resources

About