Subject(s)
Humans , Female , Adult , Crohn Disease/complications , Crohn Disease/pathology , Spleen/surgery , SplenectomyABSTRACT
Both psoriasis and inflammatory bowel disease (IBD) are immunomediated diseases. Some of their therapeutic tools are monoclonal antibodies. Ixekizumab is an interleukin-17 (IL-17) inhibitor approved for the treatment of psoriasis. Cases of IBD onset have been reported in patients treated with this drug. We present the case of a 35-year-old patient with the onset of ulcerative colitis (UC) type of IBD after starting ixekizumab treatment.
ABSTRACT
Background: ustekinumab has proven effective in Crohns disease (CD). However, some patients will partially respond or lose response over time. Data supporting the effectiveness of dose escalation in this scenario is scarce. Aim: to evaluate the effectiveness of ustekinumab dose escalation in CD. Methods: patients with active CD (Harvey-Bradshaw ≥ 5) who had received intravenous (IV) induction and at least a subcutaneous (SC) dose were included in this retrospective observational study. Ustekinumab dose was escalated, either via shortening of the interval to six or four weeks or IV reinduction plus shortening to every four weeks. Results: ninety-one patients were included, and ustekinumab dose was escalated after a median of 35 weeks of treatment. At week 16 after intensification, steroid-free clinical response and remission were observed in 62.6 % and 25.3 % of patients, respectively. Systemic corticosteroids were discontinued in 46.7 % of patients who were on corticosteroids at baseline. Follow-up data beyond week 16 were available for 78 % of patients; at the last visit, 66.2 % and 43.7 % were in steroid-free clinical response and remission, respectively. After a median follow-up of 64 weeks, 81 % of patients were still treated with ustekinumab. Adverse events were reported in 4.3 % of patients; these were all mild and did not lead to hospitalization or discontinuation of treatment. Five patients (5.5 %) underwent surgical resection, with no immediate postsurgical complications. Conclusion: ustekinumab dose escalation was effective in recapturing response in over half of the patients. These findings suggest that dose escalation should be considered in patients who experience loss or partial response to the standard maintenance.(AU)
Subject(s)
Humans , Male , Female , Ustekinumab/administration & dosage , Crohn Disease/drug therapy , Treatment Outcome , Maximum Tolerated Dose , Dosage , Gastrointestinal Diseases/classification , Gastrointestinal Diseases/diagnosis , Crohn Disease/diagnosisABSTRACT
BACKGROUND: ustekinumab has proven effective in Crohn's disease (CD). However, some patients will partially respond or lose response over time. Data supporting the effectiveness of dose escalation in this scenario is scarce. AIM: to evaluate the effectiveness of ustekinumab dose escalation in CD. METHODS: patients with active CD (Harvey-Bradshaw ≥ 5) who had received intravenous (IV) induction and at least a subcutaneous (SC) dose were included in this retrospective observational study. Ustekinumab dose was escalated, either via shortening of the interval to six or four weeks or IV reinduction plus shortening to every four weeks. RESULTS: ninety-one patients were included, and ustekinumab dose was escalated after a median of 35 weeks of treatment. At week 16 after intensification, steroid-free clinical response and remission were observed in 62.6 % and 25.3 % of patients, respectively. Systemic corticosteroids were discontinued in 46.7 % of patients who were on corticosteroids at baseline. Follow-up data beyond week 16 were available for 78 % of patients; at the last visit, 66.2 % and 43.7 % were in steroid-free clinical response and remission, respectively. After a median follow-up of 64 weeks, 81 % of patients were still treated with ustekinumab. Adverse events were reported in 4.3 % of patients; these were all mild and did not lead to hospitalization or discontinuation of treatment. Five patients (5.5 %) underwent surgical resection, with no immediate postsurgical complications. CONCLUSION: ustekinumab dose escalation was effective in recapturing response in over half of the patients. These findings suggest that dose escalation should be considered in patients who experience loss or partial response to the standard maintenance.
Subject(s)
Crohn Disease , Ustekinumab , Humans , Ustekinumab/adverse effects , Crohn Disease/drug therapy , Remission Induction , Retrospective Studies , Adrenal Cortex Hormones/therapeutic use , Treatment OutcomeABSTRACT
BACKGROUND: tofacitinib is a Janus kinase inhibitor approved for the treatment of moderate-severe ulcerative colitis (UC). This study aimed to evaluate its efficacy in a real-life setting. METHODS: a retrospective and multicenter observational study was performed with UC patients treated with tofacitinib. Short and long-term treatment effectiveness, treatment survival, need for dose escalation and safety were analyzed. Clinical response and remission were defined in accordance with the partial Mayo score. RESULTS: seventy-four patients were included, 98.3 % had received prior biological treatment, 55.4 % with three or more biologicals and up to 64.9% with two or three different mechanisms of action. Clinical remission and response rates were 37.8 % and 77 % at eight weeks, and 41.8 % and 70.1 % at 16 weeks. With regard to non-responders at eight weeks, 37.5 % achieved a delayed clinical response at 16 weeks. Mean treatment duration was 19 months (95 % CI: 16-22), with a treatment survival of 56 % at 28 months, and remission and response rates at 24 months of 53.8 % and 61.5 %. Twenty-three treatments were withdrawn, most of them (18) during the induction period. There were adverse events in a quarter of the patients; only four were severe and led to treatment discontinuation. CONCLUSION: tofacitinib has a demonstrated efficacy in clinical practice to induce and maintain clinical response in treatment-refractory UC patients, with an acceptable safety profile.
Subject(s)
Colitis, Ulcerative , Colitis, Ulcerative/chemically induced , Colitis, Ulcerative/drug therapy , Humans , Piperidines/adverse effects , Pyrimidines/adverse effects , Retrospective StudiesSubject(s)
Esophageal and Gastric Varices , Superior Vena Cava Syndrome , Varicose Veins , Esophageal and Gastric Varices/complications , Hemorrhage , Humans , Superior Vena Cava Syndrome/diagnostic imaging , Superior Vena Cava Syndrome/etiology , Varicose Veins/complications , Varicose Veins/diagnostic imagingSubject(s)
Pancreatitis , Vascular Diseases , Acute Disease , Humans , Pancreas , Pancreatitis/etiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Immunotherapy/methods , Colitis, Ulcerative/diagnosis , Colitis/chemically induced , Melanoma/drug therapy , Skin Neoplasms/drug therapy , Melanoma/secondary , Immunologic Factors/adverse effects , Diagnosis, Differential , Colitis/drug therapy , Adrenal Cortex Hormones/therapeutic use , Enterocolitis/chemically inducedSubject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antineoplastic Agents, Immunological/adverse effects , Colitis/chemically induced , Bone Neoplasms/secondary , Colitis/diagnostic imaging , Colitis/drug therapy , Colitis, Ulcerative/diagnostic imaging , Colonoscopy , Humans , Lung Neoplasms/secondary , Male , Melanoma/drug therapy , Melanoma/secondary , Middle Aged , Skin Neoplasms/drug therapySubject(s)
Colorectal Neoplasms/genetics , Genes, BRCA1 , Inflammatory Bowel Diseases/genetics , Neoplastic Syndromes, Hereditary/genetics , Adenocarcinoma/genetics , Adenocarcinoma/surgery , Adult , Age of Onset , Anti-Inflammatory Agents/therapeutic use , Azathioprine/therapeutic use , Breast Neoplasms/genetics , Colitis, Ulcerative/genetics , Colonic Neoplasms/genetics , Colonic Neoplasms/surgery , Female , Genetic Predisposition to Disease , Humans , Male , Mesalamine/therapeutic use , Proctocolectomy, RestorativeSubject(s)
Crohn Disease/prevention & control , Ustekinumab/therapeutic use , Crohn Disease/surgery , Female , Humans , Male , Middle Aged , RecurrenceABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Crohn Disease/complications , Crohn Disease/diagnostic imaging , Cerebellar Diseases/complications , Cerebellar Diseases/diagnostic imaging , Diplopia/complications , Neurosyphilis/complications , Autoimmunity/drug effects , Methylprednisolone/therapeutic use , Magnetic Resonance Imaging , Head/diagnostic imaging , Antibodies, Antinuclear/analysis , Immunosuppressive Agents/therapeutic useSubject(s)
Autoimmune Diseases of the Nervous System/etiology , Cerebellar Diseases/etiology , Crohn Disease/complications , Acute Disease , Adult , Antibodies, Antinuclear/blood , Autoimmune Diseases of the Nervous System/diagnostic imaging , Autoimmune Diseases of the Nervous System/immunology , Cerebellar Ataxia/etiology , Cerebellar Diseases/diagnostic imaging , Cerebellar Diseases/immunology , Crohn Disease/immunology , Diplopia/etiology , Humans , Magnetic Resonance Imaging , Male , Neuroimaging , Reflex, Abnormal , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/therapy , Hepatic Duct, Common/diagnostic imaging , Hepatic Duct, Common/pathology , Cholangiocarcinoma/diagnostic imaging , Anorexia/complications , Weight Loss , Abdomen/diagnostic imaging , Abdomen/pathology , Cholelithiasis/complications , Biopsy , Endoscopy, Digestive System , Cholangiocarcinoma/mortalityABSTRACT
No disponible