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BACKGROUND: Ustekinumab (UST) is commonly used to treat Crohn's disease and ulcerative colitis. However, some patients may experience diminishing response or require increased dosage. Intravenous (IV) UST maintenance is explored as a solution. OBJECTIVES: We sought to evaluate IV UST maintenance effectiveness and safety in inflammatory bowel disease patients with partial or lost subcutaneous UST response. METHODS: This was a multicenter retrospective study of inflammatory bowel disease patients on IV UST maintenance. Clinical response and remission at weeks 12 and 52, defined as Harvey-Bradshaw Index ≤4 for Crohn's disease or partial Mayo score ≤2 for ulcerative colitis. Objective markers reduction (fecal calprotectin, C-reactive protein), UST trough levels pre- and post-IV maintenance, and adverse events were assessed. RESULTS: A total of 59 patients were included. Clinical remission at weeks 12 and 52 achieved by 47.5% and 64.3% respectively. 96.6% continued IV UST at follow-up. UST serum levels quadrupled. No adverse events reported. CONCLUSIONS: IV UST maintenance effectively sustained remission in most patients at 52 weeks.
When patients lose response to subcutaneous ustekinumab, strategies include reinduction, interval shortening, and less explored intravenous maintenance. Its high rescue rate and safety profile make it a valuable option for managing active inflammatory bowel disease.
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Asunto(s)
Humanos , Femenino , Adulto , Hepatitis/complicaciones , Gripe Humana/complicaciones , Subtipo H1N1 del Virus de la Influenza A/patogenicidad , Factores de RiesgoRESUMEN
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Asunto(s)
Humanos , Masculino , Femenino , Acceso a la Información , Información de Salud al Consumidor/métodos , Servicios de Información , Herboristeria , Hepatopatías/complicaciones , Hepatopatías/diagnóstico , Toxicidad/métodos , Pruebas de Toxicidad/métodos , Pruebas de Toxicidad , 35510 , Medidas de ToxicidadRESUMEN
La ingesta de cuerpos extraños representa la segunda indicación en frecuencia para la realización de una endoscopia digestiva alta urgente. Una vez que pasan al estómago suelen expulsarse de forma espontánea, si bien un porcentaje bajo de éstos queda enclavado en la mucosa gastrointestinal por ser afilados o de gran tamaño.Las espinas de pescado son un importante número de los cuerpos extraños ingeridos.Se presentan 2 casos en que la ingesta de una espina de pescado produjo una perforación gástrica que se resolvió satisfactoriamente de forma endoscópica.La perforación se considera una contraindicación absoluta para realizar endoscopias, tanto altas como bajas, si bien casos como éstos enseñan a individualizar siempre la decisión de realizar tratamientos endoscópicos, ya que perforaciones puntiformes, sobre todo si se asocian a reacción inflamatoria parietal y peritoneal que ayude a cerrar la perforación de forma espontánea, pueden tratarse sin recurrir a cirugía(AU)
Intake of foreign bodies is the second most frequent indication for urgent upper gastrointestinal endoscopy. Once in the stomach, foreign bodies are usually spontaneously eliminated. However, a small percentage of large or sharp objects become stuck in the gastrointestinal mucosa.Fish bones represent a substantial number of ingested foreign bodies. We present two cases of fish bone intake producing gastric perforation satisfactorily resolved with endoscopy.Perforation is considered an absolute spcontraindication for upper and lower gastrointestinal endoscopy. Cases such as those reported herein indicate that the decision to perform endoscopic treatment should always be individualized since punctiform perforations especially if associated with a parietal and peritoneal inflammatory reaction that helps to close the perforation spontaneously can be treated non-surgically(AU)