Mo1895 – Efficacy of Intravenous Ustekinumab Re-Induction in Patients with Crohn’s Disease with a Loss of Response

Heron, Valérie; Panaccione, Nicola; Candido, Kristina; Bessissow, Talat; Bitton, Alain; Seow, Cynthia H.; Panaccione, Remo; Afif, Waqqas

doi:10.1016/s0016-5085(19)39162-0

Cited by 4 publications

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“…Ustekinumab levels after re-induction were higher in patients who achieved remission, and there were no serious adverse effects related to re-induction. 16 A recent single-center experience describes 13 patients who received intravenous re-induction and remained on UST at the end of the study period (median follow-up 282 days). The authors describe that in a subset of patients who lose the response, re-induction with UST can be beneficial and even allows for regular maintenance dosing every 8 weeks to continue, 18 which is similar to what we found in a per-centage of our cases.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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

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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.

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Section: Discussionmentioning

confidence: 99%

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

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“…More recently a multicenter retrospective cohort study was performed across five sites in Canada and Switzerland to evaluate the efficacy of an IV dose re-induction of UST (approximately 6 mg/kg) in 65 patients for either partial response or secondary LOR to UST, based on clinical, biochemical or endoscopic criteria. 88.3% were already optimized on q4w priori reinduction [ 40 ]. Clinical outcomes were analyzed at a median of 14 weeks (IQR: 12–19) post reinduction.…”

Section: Dose Escalation With Ustmentioning

confidence: 99%

Update on TDM (Therapeutic Drug Monitoring) with Ustekinumab, Vedolizumab and Tofacitinib in Inflammatory Bowel Disease

Restellini

Afif

2021

JCM

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The goal of therapeutic drug monitoring (TDM) is to optimize anti-TNF (tumor necrosis factor) biologic treatment in patients with inflammatory bowel disease (IBD). Although commercial assays are readily available for both ustekinumab and vedolizumab, the use of TDM with these newer biologic medications is at its infancy. The clinical utility of TDM with non-anti-TNF mechanisms of action is not clear. This review summarizes the latest available data on the pharmacokinetics of newer biologic and oral small molecules and highlights the threshold concentrations that have been associated with improved outcomes in IBD patients.

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“…Intravenous reloading in patients that are unresponsive to SC maintenance dosing has been described very scarcely in small case series only 3,4 . Indeed, this strategy may have significant merit, nevertheless it needs to be properly evaluated in prospective studies or a larger retrospective cohort that will incorporate pharmacokinetic parameters in addition to clinical, biochemical and endoscopic data.…”

mentioning

confidence: 99%

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

Kopylov

2020

Aliment Pharmacol Ther

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Mo1895 – Efficacy of Intravenous Ustekinumab Re-Induction in Patients with Crohn’s Disease with a Loss of Response

Cited by 4 publications

References 0 publications

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

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

Update on TDM (Therapeutic Drug Monitoring) with Ustekinumab, Vedolizumab and Tofacitinib in Inflammatory Bowel Disease

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

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