RESUMEN
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.
Asunto(s)
Humanos , Femenino , Adulto , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/patología , Bazo/cirugía , EsplenectomíaRESUMEN
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)
Asunto(s)
Humanos , Masculino , Femenino , Ustekinumab/administración & dosificación , Enfermedad de Crohn/tratamiento farmacológico , Resultado del Tratamiento , Dosis Máxima Tolerada , Dosificación , Enfermedades Gastrointestinales/clasificación , Enfermedades Gastrointestinales/diagnóstico , Enfermedad de Crohn/diagnósticoRESUMEN
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.
Asunto(s)
Enfermedad de Crohn , Ustekinumab , Humanos , Ustekinumab/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Inducción de Remisión , Estudios Retrospectivos , Corticoesteroides/uso terapéutico , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Colitis Ulcerosa , Colitis Ulcerosa/inducido químicamente , Colitis Ulcerosa/tratamiento farmacológico , Humanos , Piperidinas/efectos adversos , Pirimidinas/efectos adversos , Estudios RetrospectivosAsunto(s)
Pancreatitis , Enfermedades Vasculares , Enfermedad Aguda , Humanos , Páncreas , Pancreatitis/etiologíaAsunto(s)
Várices Esofágicas y Gástricas , Síndrome de la Vena Cava Superior , Várices , Várices Esofágicas y Gástricas/complicaciones , Hemorragia , Humanos , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Síndrome de la Vena Cava Superior/etiología , Várices/complicaciones , Várices/diagnóstico por imagenRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Inmunoterapia/métodos , Colitis Ulcerosa/diagnóstico , Colitis/inducido químicamente , Melanoma/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Melanoma/secundario , Factores Inmunológicos/efectos adversos , Diagnóstico Diferencial , Colitis/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Enterocolitis/inducido químicamenteAsunto(s)
Neoplasias Colorrectales/genética , Genes BRCA1 , Enfermedades Inflamatorias del Intestino/genética , Síndromes Neoplásicos Hereditarios/genética , Adenocarcinoma/genética , Adenocarcinoma/cirugía , Adulto , Edad de Inicio , Antiinflamatorios/uso terapéutico , Azatioprina/uso terapéutico , Neoplasias de la Mama/genética , Colitis Ulcerosa/genética , Neoplasias del Colon/genética , Neoplasias del Colon/cirugía , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Mesalamina/uso terapéutico , Proctocolectomía RestauradoraAsunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Colitis/inducido químicamente , Neoplasias Óseas/secundario , Colitis/diagnóstico por imagen , Colitis/tratamiento farmacológico , Colitis Ulcerosa/diagnóstico por imagen , Colonoscopía , Humanos , Neoplasias Pulmonares/secundario , Masculino , Melanoma/tratamiento farmacológico , Melanoma/secundario , Persona de Mediana Edad , Neoplasias Cutáneas/tratamiento farmacológicoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico por imagen , Enfermedades Cerebelosas/complicaciones , Enfermedades Cerebelosas/diagnóstico por imagen , Diplopía/complicaciones , Neurosífilis/complicaciones , Autoinmunidad/efectos de los fármacos , Metilprednisolona/uso terapéutico , Imagen por Resonancia Magnética , Cabeza/diagnóstico por imagen , Anticuerpos Antinucleares/análisis , Inmunosupresores/uso terapéuticoAsunto(s)
Enfermedades Autoinmunes del Sistema Nervioso/etiología , Enfermedades Cerebelosas/etiología , Enfermedad de Crohn/complicaciones , Enfermedad Aguda , Adulto , Anticuerpos Antinucleares/sangre , Enfermedades Autoinmunes del Sistema Nervioso/diagnóstico por imagen , Enfermedades Autoinmunes del Sistema Nervioso/inmunología , Ataxia Cerebelosa/etiología , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/inmunología , Enfermedad de Crohn/inmunología , Diplopía/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Reflejo Anormal , Tomografía Computarizada por Rayos XRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hemorragia Gastrointestinal/etiología , Cirrosis Hepática/complicaciones , Várices/complicaciones , Enfermedades de la Vesícula Biliar/complicaciones , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Resultado FatalRESUMEN
No disponible