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Predictors of Ustekinumab Failure in Crohn's Disease After Dose Intensification.

Authors
  • Dalal, Rahul S1
  • Njie, Cheikh2
  • Marcus, Jenna1
  • Gupta, Sanchit1
  • Allegretti, Jessica R1
  • 1 Division of Gastroenterology, Hepatology and Endoscopy, Boston, MA.
  • 2 Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Type
Published Article
Journal
Inflammatory Bowel Diseases
Publisher
Oxford University Press
Publication Date
Jul 27, 2021
Volume
27
Issue
8
Pages
1294–1301
Identifiers
DOI: 10.1093/ibd/izaa282
PMID: 33146703
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Many patients with Crohn's disease (CD) who lose response to the standard ustekinumab dose interval of every 8 weeks (q8w) undergo dose intensification to q4w or q6w. However, baseline factors that predict success or failure after dose intensification are unknown. We sought to identify predictors of failure of ustekinumab after dose intensification for patients with CD. This was a retrospective cohort study of adult CD patients undergoing ustekinumab dose intensification at a tertiary referral center between January 1, 2016, and January 31, 2019. Electronic health records were reviewed to obtain patient demographics, CD history, and laboratory data. The primary outcome was failure to achieve corticosteroid-free remission (Harvey-Bradshaw Index <5) within 12 months after intensification. The secondary outcome assessed was time to new biologic therapy after dose intensification. We used multivariable logistic regression and Cox regression to identify predictors of these outcomes. We included 123 patients who underwent ustekinumab dose intensification to q4w (n = 64), q5w (n = 1), q6w (n = 55), or q7w (n = 3). Multivariable logistic regression demonstrated that perianal disease, Harvey-Bradshaw Index, and opioid use at time of intensification were associated with failure to achieve remission. Cox regression demonstrated that perianal disease and corticosteroid use at time of intensification were associated with shorter time to a new biologic. Perianal disease, Harvey-Bradshaw Index, current opioid use, and current corticosteroid use are associated with ustekinumab failure after dose intensification in CD. Larger, prospective studies are needed to corroborate these findings and guide therapeutic strategies for patients who lose response to standard ustekinumab dosing. © 2020 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected]

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