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- Title
Effectiveness of ustekinumab dose escalation in Crohn's disease patients with insufficient response to standard‐dose subcutaneous maintenance therapy.
- Authors
Kopylov, Uri; Hanzel, Jurij; Liefferinckx, Claire; De Marco, Davide; Imperatore, Nicola; Plevris, Nikolas; Baston‐Rey, Iria; Harris, Richard J.; Truyens, Marie; Domislovic, Viktor; Vavricka, Stephan; Biemans, Vince; Myers, Sally; Sebastian, Shaji; Ben‐Horin, Shomron; González Lama, Yago; Gilletta, Cyrielle; Ariella, Bar‐Gil Shitrit; Zelinkova, Zuzana; Weisshof, Roni
- Abstract
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.
- Subjects
CROHN'S disease; SUBCUTANEOUS injections; DISEASE remission
- Publication
Alimentary Pharmacology & Therapeutics, 2020, Vol 52, Issue 1, p135
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/apt.15784