Re-induction With Intravenous Ustekinumab in Patients With Crohn's Disease and a Loss of Response to This Therapy. Issue 1 (2nd February 2021)

• Record Type: Journal Article
• Authors: Bermejo, Fernando; Jiménez, Laura; Algaba, Alicia; Vela, Milagros; Bastida, Guillermo; Merino, Olga; López-García, Alicia; Melcarne, Luigi; Rodríguez-Lago, Iago; de la Maza, Saioa; Bouhmidi, Abdel; Barreiro-de Acosta, Manuel; López-Serrano, Pilar; Carrillo-Palau, Marta; Mesonero, Francisco; Orts, Beatriz; Bonillo, Daniel; Granja, Alicia; Guerra, Iván
• Is Part Of: Inflammatory bowel diseases. Volume 28:Issue 1(2022)
• Page Start: 41
• Page End: 47
• Publication Date: 2021-02-02
• Subjects: Crohn's disease -- ustekinumab -- re-induction -- loss of response; Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izab015
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: 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.