Rates, predictive factors and effectiveness of ustekinumab intensification to 4- or 6-weekly intervals in Crohn's disease

Lauranne A A P Derikx; Nikolas Plevris; Shanna Su; Beatriz Gros; Mathew Lyons; Spyros I Siakavellas; Nathan Constantine-Cooke; Philip Jenkinson; Claire O'Hare; Colin Noble; Ian D Arnott; Gareth-Rhys Jones; Charlie W Lees

doi:10.1016/j.dld.2022.10.002

Rates, predictive factors and effectiveness of ustekinumab intensification to 4- or 6-weekly intervals in Crohn's disease

Lauranne A A P Derikx, Nikolas Plevris, Shanna Su, Beatriz Gros, Mathew Lyons, Spyros I Siakavellas, Nathan Constantine-Cooke, Philip Jenkinson, Claire O'Hare, Colin Noble, Ian D Arnott, Gareth-Rhys Jones, Charlie W Lees

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

BACKGROUND: The UNITI trial reports efficacy of ustekinumab (UST) dose intensification in Crohn's disease (CD) from 12- to 8-weekly, but not 4-weekly. We aimed 1) to assess the cumulative incidence of UST dose intensification to 4- or 6-weekly, 2) to identify factors associated with dose intensification, and 3) to assess the effectiveness of this strategy.

METHODS: We performed a retrospective, observational cohort study in NHS Lothian including all UST treated CD patients (2015-2020).

RESULTS: 163 CD patients were treated with UST (median follow-up: 20.3 months [13.4-38.4]), of whom 55 (33.7%) underwent dose intensification to 4-weekly (n = 50, 30.7%) or 6-weekly (n = 5, 3.1%). After 1 year 29.9% were dose intensified. Prior exposure to both anti-TNF and vedolizumab (HR 9.5; 1.3-70.9), and concomitant steroid use at UST start (HR 1.8; 1.0-3.1) were associated with dose intensification. Following dose intensification, 62.6% patients (29/55) remained on UST beyond 1 year. Corticosteroid-free clinical remission was achieved in 27% at week 16 and 29.6% at last follow-up.

CONCLUSION: One third of CD patients treated with UST underwent dose intensification to a 4- or 6-weekly interval within the first year. Patients who failed both anti-TNF and vedolizumab, or required steroids at initiation were more likely to dose intensify.

Original language	English
Pages (from-to)	1034-1041
Number of pages	8
Journal	Digestive and Liver Disease
Volume	55
Issue number	8
DOIs	https://doi.org/10.1016/j.dld.2022.10.002
Publication status	Published - 1 Aug 2023

Keywords / Materials (for Non-textual outputs)

Crohn Disease/drug therapy
Ustekinumab/therapeutic use
Dermatologic Agents/therapeutic use
Humans
Retrospective Studies
Treatment Outcome
Male
Female
Adolescent
Adult

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Derikx, L. A. A. P., Plevris, N., Su, S., Gros, B., Lyons, M., Siakavellas, S. I., Constantine-Cooke, N., Jenkinson, P., O'Hare, C., Noble, C., Arnott, I. D., Jones, G.-R., & Lees, C. W. (2023). Rates, predictive factors and effectiveness of ustekinumab intensification to 4- or 6-weekly intervals in Crohn's disease. Digestive and Liver Disease, 55(8), 1034-1041. https://doi.org/10.1016/j.dld.2022.10.002

@article{b806f353a37e45be940d36a7c3f3cfd8,

title = "Rates, predictive factors and effectiveness of ustekinumab intensification to 4- or 6-weekly intervals in Crohn's disease",

abstract = "BACKGROUND: The UNITI trial reports efficacy of ustekinumab (UST) dose intensification in Crohn's disease (CD) from 12- to 8-weekly, but not 4-weekly. We aimed 1) to assess the cumulative incidence of UST dose intensification to 4- or 6-weekly, 2) to identify factors associated with dose intensification, and 3) to assess the effectiveness of this strategy.METHODS: We performed a retrospective, observational cohort study in NHS Lothian including all UST treated CD patients (2015-2020).RESULTS: 163 CD patients were treated with UST (median follow-up: 20.3 months [13.4-38.4]), of whom 55 (33.7%) underwent dose intensification to 4-weekly (n = 50, 30.7%) or 6-weekly (n = 5, 3.1%). After 1 year 29.9% were dose intensified. Prior exposure to both anti-TNF and vedolizumab (HR 9.5; 1.3-70.9), and concomitant steroid use at UST start (HR 1.8; 1.0-3.1) were associated with dose intensification. Following dose intensification, 62.6% patients (29/55) remained on UST beyond 1 year. Corticosteroid-free clinical remission was achieved in 27% at week 16 and 29.6% at last follow-up.CONCLUSION: One third of CD patients treated with UST underwent dose intensification to a 4- or 6-weekly interval within the first year. Patients who failed both anti-TNF and vedolizumab, or required steroids at initiation were more likely to dose intensify.",

keywords = "Crohn Disease/drug therapy, Ustekinumab/therapeutic use, Dermatologic Agents/therapeutic use, Humans, Retrospective Studies, Treatment Outcome, Male, Female, Adolescent, Adult",

author = "Derikx, {Lauranne A A P} and Nikolas Plevris and Shanna Su and Beatriz Gros and Mathew Lyons and Siakavellas, {Spyros I} and Nathan Constantine-Cooke and Philip Jenkinson and Claire O'Hare and Colin Noble and Arnott, {Ian D} and Gareth-Rhys Jones and Lees, {Charlie W}",

note = "Copyright {\textcopyright} 2022. Published by Elsevier Ltd.",

year = "2023",

month = aug,

day = "1",

doi = "10.1016/j.dld.2022.10.002",

language = "English",

volume = "55",

pages = "1034--1041",

journal = "Digestive and Liver Disease",

issn = "1590-8658",

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Derikx, LAAP, Plevris, N, Su, S, Gros, B, Lyons, M, Siakavellas, SI, Constantine-Cooke, N, Jenkinson, P, O'Hare, C, Noble, C, Arnott, ID, Jones, G-R & Lees, CW 2023, 'Rates, predictive factors and effectiveness of ustekinumab intensification to 4- or 6-weekly intervals in Crohn's disease', Digestive and Liver Disease, vol. 55, no. 8, pp. 1034-1041. https://doi.org/10.1016/j.dld.2022.10.002

TY - JOUR

T1 - Rates, predictive factors and effectiveness of ustekinumab intensification to 4- or 6-weekly intervals in Crohn's disease

AU - Derikx, Lauranne A A P

AU - Plevris, Nikolas

AU - Su, Shanna

AU - Gros, Beatriz

AU - Lyons, Mathew

AU - Siakavellas, Spyros I

AU - Constantine-Cooke, Nathan

AU - Jenkinson, Philip

AU - O'Hare, Claire

AU - Noble, Colin

AU - Arnott, Ian D

AU - Jones, Gareth-Rhys

AU - Lees, Charlie W

PY - 2023/8/1

Y1 - 2023/8/1

N2 - BACKGROUND: The UNITI trial reports efficacy of ustekinumab (UST) dose intensification in Crohn's disease (CD) from 12- to 8-weekly, but not 4-weekly. We aimed 1) to assess the cumulative incidence of UST dose intensification to 4- or 6-weekly, 2) to identify factors associated with dose intensification, and 3) to assess the effectiveness of this strategy.METHODS: We performed a retrospective, observational cohort study in NHS Lothian including all UST treated CD patients (2015-2020).RESULTS: 163 CD patients were treated with UST (median follow-up: 20.3 months [13.4-38.4]), of whom 55 (33.7%) underwent dose intensification to 4-weekly (n = 50, 30.7%) or 6-weekly (n = 5, 3.1%). After 1 year 29.9% were dose intensified. Prior exposure to both anti-TNF and vedolizumab (HR 9.5; 1.3-70.9), and concomitant steroid use at UST start (HR 1.8; 1.0-3.1) were associated with dose intensification. Following dose intensification, 62.6% patients (29/55) remained on UST beyond 1 year. Corticosteroid-free clinical remission was achieved in 27% at week 16 and 29.6% at last follow-up.CONCLUSION: One third of CD patients treated with UST underwent dose intensification to a 4- or 6-weekly interval within the first year. Patients who failed both anti-TNF and vedolizumab, or required steroids at initiation were more likely to dose intensify.

AB - BACKGROUND: The UNITI trial reports efficacy of ustekinumab (UST) dose intensification in Crohn's disease (CD) from 12- to 8-weekly, but not 4-weekly. We aimed 1) to assess the cumulative incidence of UST dose intensification to 4- or 6-weekly, 2) to identify factors associated with dose intensification, and 3) to assess the effectiveness of this strategy.METHODS: We performed a retrospective, observational cohort study in NHS Lothian including all UST treated CD patients (2015-2020).RESULTS: 163 CD patients were treated with UST (median follow-up: 20.3 months [13.4-38.4]), of whom 55 (33.7%) underwent dose intensification to 4-weekly (n = 50, 30.7%) or 6-weekly (n = 5, 3.1%). After 1 year 29.9% were dose intensified. Prior exposure to both anti-TNF and vedolizumab (HR 9.5; 1.3-70.9), and concomitant steroid use at UST start (HR 1.8; 1.0-3.1) were associated with dose intensification. Following dose intensification, 62.6% patients (29/55) remained on UST beyond 1 year. Corticosteroid-free clinical remission was achieved in 27% at week 16 and 29.6% at last follow-up.CONCLUSION: One third of CD patients treated with UST underwent dose intensification to a 4- or 6-weekly interval within the first year. Patients who failed both anti-TNF and vedolizumab, or required steroids at initiation were more likely to dose intensify.

KW - Crohn Disease/drug therapy

KW - Ustekinumab/therapeutic use

KW - Dermatologic Agents/therapeutic use

KW - Humans

KW - Retrospective Studies

KW - Treatment Outcome

KW - Male

KW - Female

KW - Adolescent

KW - Adult

U2 - 10.1016/j.dld.2022.10.002

DO - 10.1016/j.dld.2022.10.002

M3 - Article

C2 - 36283944

SN - 1590-8658

VL - 55

SP - 1034

EP - 1041

JO - Digestive and Liver Disease

JF - Digestive and Liver Disease

IS - 8

ER -

Rates, predictive factors and effectiveness of ustekinumab intensification to 4- or 6-weekly intervals in Crohn's disease

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