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.
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.
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.
In this multicenter study, two-thirds of patients recaptured response following treatment intensification with ustekinumab 90 mg every 4 weeks.
© The Author(s) 2020. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.
About The Expert
Mathurin Fumery
Laurent Peyrin-Biroulet
Stephane Nancey
Romain Altwegg
Cyrielle Gilletta
Pauline Veyrard
Guillaume Bouguen
Stephanie Viennot
Florian Poullenot
Jerome Filippi
Anthony Buisson
Anne Bozon
Franck Brazier
Lieven Pouillon
Bernard Flourie
Lucile Boivineau
Laurent Siproudhis
David Laharie
Xavier Roblin
Momar Diouf
Xavier Treton
References
PubMed