Ustekinumab for prevention of postoperative recurrence: Our clinical experience

Toutouh, Samia Hallouch; Saéz, Marta Lázaro; Martínez, Álvaro Hernández

doi:10.1016/j.gastre.2020.06.019

Cited by 3 publications

(3 citation statements)

References 2 publications

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“…The role of UST as an option for POR management has been assessed by some recent studies, whose results were not univocal. While some authors showed that UST could be effective in this setting, 22–25 these findings were not confirmed in other cohorts, 26,27 although sample sizes were limited. However, it is very important to emphasize how in all the aforementioned studies UST was initiated as postoperative medical prophylaxis within few months from surgery.…”

Section: Discussionmentioning

confidence: 94%

“…Regarding UST, some recent studies assessed its role in a postoperative setting, showing conflicting results. [22][23][24][25][26][27] To be noticed, in all these studies UST was started as postoperative prophylaxis within few months from surgery in order to prevent POR, while no data on the efficacy of UST for the treatment of endoscopically documented POR following ileocolic resection is available.…”

Section: Introductionmentioning

confidence: 99%

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Ustekinumab is a promising option for the treatment of postoperative recurrence of Crohn's disease

Macaluso

Grova

Mocciaro

et al. 2023

J of Gastro and Hepatol

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Background and AimPostoperative recurrence (POR) following ileocolonic resection is a major concern in patients with Crohn's disease (CD). The role of ustekinumab (UST) in this setting is poorly known.MethodsAll consecutive CD patients with a baseline colonoscopy at 6–12 months from ileocolonic resection showing POR (Rutgeerts score ≥ i2) who were treated with UST after the baseline colonoscopy and with an available post‐treatment endoscopy, were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Diseases (SN‐IBD). The primary outcome was endoscopic success, defined as reduction of at least one point of Rutgeerts score. The secondary outcome was clinical success, assessed at the end of follow‐up. Reasons for clinical failure included mild clinical relapse (Harvey–Bradshaw index 5–7), clinically relevant relapse (Harvey–Bradshaw index > 7), and need for new resection.ResultsForty‐four patients were included (mean follow‐up: 17.8 ± 8.4 months). The baseline postoperative colonoscopy showed severe POR (Rutgeerts score i3 or i4) in 75.0% of patients. The post‐treatment colonoscopy was performed after a mean of 14.5 ± 5.5 months following initiation of UST. Endoscopic success was reported in 22 out of 44 (50.0%) patients, of whom 12 (27.3%) achieved a Rutgeerts score i0 or i1. Clinical success at the end of follow‐up was reported in 32 out of 44 patients (72.7%); none of the 12 patients with clinical failure had achieved endoscopic success at post‐treatment colonoscopy.ConclusionsUstekinumab could be a promising option for the treatment of POR of CD.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Ustekinumab is a promising option for the treatment of postoperative recurrence of Crohn's disease

Macaluso

Grova

Mocciaro

et al. 2023

J of Gastro and Hepatol

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“…The rate of endoscopic POR in the studies evaluating the efficacy of ustekinumab in the postoperative setting is summarised in Table 4 [ 67 , 68 , 71 , 72 , 166 , 174 , 175 ]. In total, seven studies, all observational and included 162 patients, were identified.…”

Section: Biological Agents Other Than Anti-tnfsmentioning

confidence: 99%

Anti-TNF Agents and New Biological Agents (Vedolizumab and Ustekinumab) in the Prevention and Treatment of Postoperative Recurrence After Surgery in Crohn’s Disease

Gisbert,

Chaparro

2023

Drugs

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Surgery for Crohn’s disease (CD) is not curative, as postoperative recurrence (POR) after ileocolonic resection is the rule in the absence of prophylactic treatment. In the present article, we critically review available data on the role of anti-tumour necrosis factor (TNF) agents and new biologics (including vedolizumab and ustekinumab) in the prevention and treatment of POR after surgery in CD. Several studies (summarised in various meta-analyses) have confirmed the efficacy of anti-TNFs in the prevention of POR. We identified 37 studies, including 1863 CD patients, with mean endoscopic POR at 6–12 months of 29%. Only few randomised controlled trials (RCTs) have directly compared thiopurines and anti-TNFs, with controversial results, although the superiority of the latter is supported by several meta-analyses. Infliximab and adalimumab seem equally effective. The combination of anti-TNFs and immunosuppressives should be considered in patients previously exposed to anti-TNFs. Several studies have shown that anti-TNFs remain an effective option to prevent POR also in patients with anti-TNF failure before surgery. In fact, the use of the same anti-TNF before and after surgery might be effective for the prevention of POR. Prophylactic anti-TNF treatment, once started, should be continued long term. Anti-TNFs are also effective for the treatment of established POR. Retreatment with anti-TNFs for POR is a valid strategy even after their preoperative failure. In six studies (including 156 patients) evaluating vedolizumab, mean endoscopic POR at 6–12 months was 41%. The non-randomised comparison of anti-TNFs and vedolizumab has provided controversial results. One placebo-controlled RCT confirmed that vedolizumab is quite effective in preventing POR in CD patients with increased risk of recurrence. Seven studies (including 162 patients) evaluated ustekinumab, with a mean endoscopic POR at 6–12 months of 41%. The comparative efficacy of ustekinumab and anti-TNFs is still unclear. Ustekinumab and vedolizumab seem to be equally effective, although the experience is very limited. In conclusion, to date, anti-TNFs are the most effective agents in preventing and treating POR in CD. Anti-TNFs remain an effective option to prevent POR also in patients with anti-TNF failure before surgery. Vedolizumab seems to be quite effective in the prevention of POR in patients with increased risk of recurrence. Ustekinumab is probably also effective in the postoperative setting, although the comparative efficacy with anti-TNFs or vedolizumab is still unclear.

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Anti -TNFα agents in preventing the postoperative recurrence of Crohn’s disease: Do they still play a role in the biological era?

Liu

Zhan

et al. 2021

Expert Opinion on Biological Therapy

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Ustekinumab for prevention of postoperative recurrence: Our clinical experience

Cited by 3 publications

References 2 publications

Ustekinumab is a promising option for the treatment of postoperative recurrence of Crohn's disease

Ustekinumab is a promising option for the treatment of postoperative recurrence of Crohn's disease

Anti-TNF Agents and New Biological Agents (Vedolizumab and Ustekinumab) in the Prevention and Treatment of Postoperative Recurrence After Surgery in Crohn’s Disease

Anti -TNFα agents in preventing the postoperative recurrence of Crohn’s disease: Do they still play a role in the biological era?

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