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Melotti L, Dussias NK, Salice M, Calabrese C, Baldoni M, Scaioli E, Belluzzi A, Mazzotta E, Gionchetti P, Rizzello F. Effectiveness of swapping to ustekinumab after vedolizumab failure in patients with multi-refractory Crohn's disease. Dig Liver Dis 2023; 55:230-234. [PMID: 35879185 DOI: 10.1016/j.dld.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ustekinumab (UST) and vedolizumab (VDZ) are biologic therapies for moderate-to-severe Crohn's disease (CD) in patients who failed or had contraindication to anti-TNF treatment. AIMS To evaluate ustekinumab efficacy as third-line treatment after swapping from VDZ for failure. METHODS We conducted a monocentric, retrospective, observational study where CD patients were followed for 12 months from the beginning of UST therapy. We assessed clinical activity (HBI) and laboratory markers (CRP) at the initiation of UST therapy (T0) and after 2(T2), 6(T6) and 12(T12) months. Endoscopic activity was recorded at T0 and T12. We registered data regarding their clinical history and previous biologic treatments. Steroid-free clinical remission was defined as HBI ≤ 4 without need for steroids. Clinical response was defined as HBI reduction of at least three points or the suspension of steroids. RESULTS 27 CD patients treated with UST after VDZ failure had a minimum follow up of 12 months and were included. All patients had previously been treated with anti-TNF agents. After 12 months, steroid-free clinical remission was evident in 15 (55.5%) patients, 5 (18.5%) had clinical response, while 7 (26%) had suspended for failure or persisted on treatment after optimization. CONCLUSIONS Ustekinumab should be considered as third-line biologic treatment in multi-refractory CD patients.
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Affiliation(s)
- Laura Melotti
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
| | - Nikolas Konstantine Dussias
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
| | - Marco Salice
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Carlo Calabrese
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
| | - Monia Baldoni
- DIMEC, sezione Gastroenterologia, Università degli studi di Perugia, Italy
| | - Eleonora Scaioli
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Andrea Belluzzi
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Elena Mazzotta
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Paolo Gionchetti
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy.
| | - Fernando Rizzello
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
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Gonczi L, Szanto K, Farkas K, Molnar T, Szamosi T, Schafer E, Golovics PA, Barkai L, Lontai L, Lovasz B, Juhasz M, Patai A, Sarang K, Vincze A, Sarlos P, Farkas A, Dubravcsik Z, Toth TG, Miheller P, Ilias A, Lakatos PL. Clinical efficacy, drug sustainability and serum drug levels in Crohn's disease patients treated with ustekinumab - A prospective, multicenter cohort from Hungary. Dig Liver Dis 2022; 54:207-213. [PMID: 34344576 DOI: 10.1016/j.dld.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although efficacy of ustekinumab (UST) has been demonstrated through randomized trials, data from real-life prospective cohorts are still limited. Our aim was to evaluate clinical efficacy, drug sustainability, dose intensification and results from therapeutic drug monitoring in UST treated patients with Crohn's disease (CD) using a prospective, nationwide, multicenter cohort. METHODS Patients from 10 Inflammatory Bowel Disease centers were enrolled between 2019 January and 2020 May. Patient demographics, disease phenotype, treatment history, clinical disease activity (Crohn's Disease Activity Index(CDAI), Harvey Bradshaw Index(HBI)), biomarkers, and serum drug levels were obtained. Evaluations were performed at week8 (post-induction), w16-20, w32-36, and w52-56 follow-up visits. RESULTS A total of 142 patients were included [57.4% female; complex disease behavior (B2/B3):48%, previous anti-TNF exposition:97%]. Clinical response and remission rates after induction(w8) were 78.1% and 57.7% using CDAI, and 82.5% and 51.8% based on HBI scores. The one-year clinical remission rate was 58%/57.3%(CDAI/HBI). Composite clinical and biomarker remission (CDAI<150 and C-reactive protein<10 mg/L) rates were 35.4%; 33.3%; 38.6% and 36.6% at w8/w16-20/w32-36 and w52-56. Drug sustainability was 81.9%(standard deviation(SD): 3.4) at 1 year(1y). Probability of dose intensification was high and introduced early, 42.2%(SD:4.2) at ~w32 and 51.9%(SD:4.4%) at 1y. CONCLUSION Ustekinumab showed favorable drug sustainability and clinical efficacy in a patient population with severe disease phenotype and previous anti-tumor necrosis factor (anti-TNF) failure, however frequent dose intensification was required.
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Affiliation(s)
- Lorant Gonczi
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Kata Szanto
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamas Molnar
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamas Szamosi
- Department of Gastroenterology, Military Hospital-State Health Center, Budapest, Hungary
| | - Eszter Schafer
- Department of Gastroenterology, Military Hospital-State Health Center, Budapest, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Military Hospital-State Health Center, Budapest, Hungary
| | - Laszlo Barkai
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Livia Lontai
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Barbara Lovasz
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Mark Juhasz
- Department of Medicine, St. Margit Hospital, Budapest, Hungary
| | - Arpad Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Krisztina Sarang
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Aron Vincze
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Patricia Sarlos
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Alexandra Farkas
- Department of Gastroenterology, Bács-Kiskun County Hospital, Kecskemet, Hungary
| | - Zsolt Dubravcsik
- Department of Gastroenterology, Bács-Kiskun County Hospital, Kecskemet, Hungary
| | - Tamas G Toth
- Department of Gastroenterology, St. Janos Hospital, Budapest, Hungary
| | - Pal Miheller
- 1st Department of Surgery and Interventional Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Akos Ilias
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Peter L Lakatos
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary; McGill University Health Center, Montreal General Hospital, Canada.
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Abstract
The advent of biologics targeting tumor necrosis factor-alpha (TNF-alpha) has revolutionized the field of rheumatology in general and the treatment of spondyloarthritis (SpA) in particular, since - apart from non-steroidal anti-inflammatory agents - no disease modifying treatments are available for this frequent, inflammatory rheumatic condition. The significant improvements in signs and symptoms observed with TNF-blockers in this group of diseases, have raised the bar with regard to treatment goals, including clinical remission. Even if treatment failure with TNF-blocking agents may be a relatively rare phenomenon, cases of primary non-responders, secondary loss-of-efficacy and intolerance, have been described. Results with abatacept, rituximab and tocilizumab - all effective in the treatment of rheumatoid arthritis - were disappointing, especially in patients that had previously failed anti-TNF therapy. On the other hand, there is increasing evidence that targeting the cytokines of the Th-17 axis is associated with major improvements of skin psoriasis and its associated arthritis. In axial spondyloarthritis, preliminary proof-of-concept studies with ustekinumab and interleukin-17 targeting therapies suggest that these agents could become the first new treatment options, not targeting TNF. Finally, the advent of small molecules targeting inflammatory, intracellular signalling pathways, may further change our future therapeutic approach.
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Affiliation(s)
| | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases (OP09), Oregon Health & Science University, Portland, OR, USA
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