Year 2019 / Volume 111 / Number 9
Letter
Intravenous ustekinumab reinduction as a Crohn’s disease rescue strategy following a secondary non-response

721

DOI: 10.17235/reed.2019.5802/2018

Juan María Vázquez Morón, Rafael Rodríguez Moncada, Héctor Pallarés Manrique,

Abstract
Secondary non-response to biological treatments tends to occur in a high number of patients who undergo treatment with antiTNF, and it has also been observed in patients treated with vedolizumab or ustekinumab. The initial rescue guideline recommends intensifying the treatment by reducing the interval or increasing maintenance dosage. In the case of ustekinumab, the patients who began this treatment prior to its approval for treatment of Crohn’s disease, were given a subcutaneous induction with no defined guideline and a maintenance dosage of 90 mg every eight weeks. Following secondary non-response in these patients, it was proposed that rescue be undertaken via intravenous reinduction adjusted for weight. We present a case of a patient with Crohn’s disease with failure to respond to infliximab, adalimumab and vedolizumab who began treatment with ustekinumab prior to official approval. There was non-response at eight months but remission was achieved after reinduction with ustekinumab, adjusted for weight. This rescue guideline could be a cost-effective way to reinduce remission in this group of patients.
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References
1. Baert F, Glorieus E, Reenaers C, et al. Adalimumab dose escalation and dose de-escalation success rate and predictors in a large national cohort of crohn’s patients. Journal of Crohn’s and Colitis 2013; 7: 154–60.
2. Kopylov U, Mantzaris GJ, Katsanos KH, et al. The efficacy of shortening the dosing interval to once every six weeks in crohn’s patients losing response to maintenance dose of infliximab. Aliment Pharmacol Ther 2011; 33: 349–57.
3. Ma C , Fedorak RN , Kaplan GG, et al. Long-term maintenance of clinical, endoscopic, and radiographic response to ustekinumab in moderateto-severe Crohn’s disease: real-world experience from a multicenter cohort study. Inflamm Bowel Dis 2017; 23: 833 – 9.
4. Srinivasan A, Vasudevan A, McFarlane A, et al. Anti-TNF re-induction is as effective, simpler and cheaper compared with dose interval shortening for secondary loss of response in Crohn´s disease. J Crohns Colitis 2018 Feb 28; 12(3): 280-288.
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Vázquez Morón J, Rodríguez Moncada R, Pallarés Manrique H. Intravenous ustekinumab reinduction as a Crohn’s disease rescue strategy following a secondary non-response . 5802/2018


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Publication history

Received: 30/06/2018

Accepted: 04/10/2018

Online First: 23/07/2019

Published: 05/09/2019

Article revision time: 71 days

Article Online First time: 388 days

Article editing time: 432 days


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