Mo1882 EFFECTIVENESS OF USTEKINUMAB DOSE ESCALATION IN CROHN'S DISEASE

Ollech, Jacob; Normatov, Inessa; Peleg, Noam; Patel, Shivani A.; Rai, Victoria; Wang, Jingzhou D.; Yi, Yangtian; Singer, Jorie; Dalal, Sushila; Sakuraba, Atsushi; Cohen, Russell D.; Rubin, David T.; Pekow, Joel

doi:10.1016/s0016-5085(20)33079-1

Cited by 5 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some studies reported outcomes after a combination of intravenous reinduction with a dose escalation strategy, with an effectiveness in about half of patients (3,10). More recently, the Chicago group had reported the effectiveness of ustekinumab dose escalation to q4W in 110 patients with CD followed with a median time of 9 months (9). Clinical response as defined by Harvey-Bradshaw score improvement was observed in 42% of the 78 patients with available data.…”

Section: Discussionmentioning

confidence: 99%

“…Some real-word studies reported the experience with ustekinumab intensification from 90 mg q8W to q4W and even to q3W (2)(3)(4)8). Recently, the University of Chicago group reported the effectiveness of ustekinumab dose interval shortening from 90 mg q8W to q4W in 51 patients with Harvey-Bradshaw score > 4 (9). They showed that dose escalation resulted in improvement in clinical indices of disease activity.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness and Safety of Ustekinumab Intensification at 90 mg Every 4 Weeks in Crohn’s Disease: A Multicentre Study

Fuméry

Peyrin–Biroulet

Nancey

et al. 2020

Journal of Crohn's and Colitis

View full text Add to dashboard Cite

Introduction The approved maintenance regimens for ustekinumab in Crohn’s disease (CD) are 90 mg every 8 or 12 weeks. Some patients will partially respond to ustekinumab or will experience a secondary loss of response. It remains poorly known if these patients may benefit from shortening the interval between injections Methods All patients with active CD, as defined by Harvey-Bradshaw score ≥ 4 and one objective sign of inflammation (CRP > 5 mg/L and/or fecal calprotectin > 250 µg/g and/or radiologic and/or endoscopic evidence of disease activity) who required ustekinumab dose escalation to 90mg every 4 weeks for loss of response or incomplete response to ustekinumab 90mg every 8 weeks were included in this retrospective multicenter cohort study. Results One hundred patients, with a median age of 35 years (Interquartile Range (IQR), 28 – 49) and median disease duration of 12 (7 – 20) years were included. Dose intensification was performed after a median of 5.0 (2.8 - 9.0) months of ustekinumab treatment and was associated with corticosteroids and immunosuppressants in respectively 29% and 27% of cases. Short-term clinical response and clinical remission were observed in respectively 61% and 31% after a median of 2.4 (1.3 - 3.0) months. After a median follow-up of 8.2 (5.6-12.4) months, 61% of patients were still treated with ustekinumab, and 26% in steroid-free clinical remission. Among the 39 patients with colonoscopy during follow-up, 14 achieved endoscopic remission (no ulcers). At the end of follow-up, 27% of patients were hospitalized, and 19% underwent intestinal resection surgery. Adverse events were reported in 12% of patients, including five serious adverse events. Conclusion In this multicenter study, two-thirds of patients recaptured response following treatment intensification with ustekinumab 90 mg every 4 weeks.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of Ustekinumab Intensification at 90 mg Every 4 Weeks in Crohn’s Disease: A Multicentre Study

Fuméry

Peyrin–Biroulet

Nancey

et al. 2020

Journal of Crohn's and Colitis

View full text Add to dashboard Cite

show abstract

“…However, some recent studies report clinical outcomes derived from specific real-world cohorts consisting of only dose optimized patients [11,[23][24][25]. Where reported, 22-52% of patients needed dose intensification, which appeared successful in around half of the patients [10,11,[22][23][24][25].In the present study, one-third of patients on ustekinumab maintenance therapy required dose intensification. Among patients initiating maintenance therapy with q12w dosing, two-thirds shortened the interval.…”

Section: Discussionmentioning

confidence: 52%

“…While the analysis of dosing patterns in IM-UNITI trial suggested regaining clinical response in 55% of patients following dose intensification from q12w to q8w [3,21], data on dose optimization in real-world situations remains scarce [10,22]. However, some recent studies report clinical outcomes derived from specific real-world cohorts consisting of only dose optimized patients [11,[23][24][25]. Where reported, 22-52% of patients needed dose intensification, which appeared successful in around half of the patients [10,11,[22][23][24][25].In the present study, one-third of patients on ustekinumab maintenance therapy required dose intensification.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A nationwide real-world study on dynamic ustekinumab dosing and concomitant medication use among Crohn’s disease patients in Finland

Sipponen

Björkesten

Hallinen

et al. 2021

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

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.

show abstract