Intensificación de Ustekinumab en enfermedad de Crohn: Revisión sistemática

  1. Tania González Furelos 1
  2. María Sobrido Prieto 1
  3. Iria Rodríguez Legazpi 1
  1. 1 Universidade da Coruña
    info

    Universidade da Coruña

    La Coruña, España

    ROR https://ror.org/01qckj285

Revista:
Ars pharmaceutica

ISSN: 2340-9894 0004-2927

Ano de publicación: 2022

Volume: 63

Número: 4

Páxinas: 345-354

Tipo: Artigo

DOI: 10.30827/ARS.V63I4.24740 DIALNET GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: Ars pharmaceutica

Resumo

Introduction: Ustekinumab emerges as a therapeutic alternative in Crohn’s disease in patients with anti-TNF failure. However, on many occasions, it is common to have to reduce/shorten their administration times to avoid thera-peutic failure. The objective of this systematic review is to evaluate the effectiveness of ustekinumab intensification by shortening its therapeutic interval. Method: A systematic review of the literature based on the guidelines of the PRISMA statement was performed. The Medline, Embase and Web of Science databases were consulted, including studies with adults diagnosed with moderate or severe Crohn’s disease who had undergone a change in ustekinumab dosage as an intervention by shortening the interval to every 4 weeks. Results: Five articles were included, one of them being a systematic review. At 6 months, clinical remission rates of around 45% are shown, an average reduction of 3 points in the Harvey Bradshaw index over baseline, as well as a normalization of CRP levels in 21% of patients. Conclusions: The results support the use of ustekinumab interval shortening as an effective and useful therapeutic option for patients with loss of response to the usual regimen. However, it is recommended to carry out new studies of experimental design that increase the level of existing evidence.

Referencias bibliográficas

  • Aguiar Zdovc J, Hanžel J, Kurent T, Sever N, Koželj M, Smrekar N, et al. Ustekinumab Dosing Indi-vidualization in Crohn’s Disease Guided by a Population Pharmacokinetic-Pharmacodynamic Model. Pharmaceutics. 2021; 13(10):1587. DOI: 10.3390/pharmaceutics13101587
  • Chaparro M, Garre A, Núñez Ortiz A, Diz-Lois Palomares MT, Rodríguez C, Riestra S, et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epide-miological Study. J Clin Med. 2021; 10(13):2885. DOI: 10.3390/jcm10132885
  • Dalal RS, Njie C, Marcus J, Gupta S, Allegretti JR. Predictors of Ustekinumab Failure in Crohn’s Disea-se After Dose Intensification. Inflamm Bowel Dis. 2021; 27(8):1294–301. DOI: 10.1093/ibd/izaa282
  • Fumery M, Peyrin-Biroulet L, Nancey S, Altwegg R, Gilletta C, Veyrard P, et al. Effectiveness and Sa-fety of Ustekinumab Intensification at 90 mg Every 4 Weeks in Crohn’s Disease: A Multicentre Study. J Crohns Colitis. 2021; 15(2):222–7. DOI: 10.1093/ecco-jcc/jjaa177
  • Haider SA, Yadav A, Perry C, Su L, Akanbi O, Kudaravalli P, et al. Ustekinumab dose escalation improves clinical responses in refractory Crohn’s disease. Therap Adv Gastroenterol. 2020; 13:1756284820959245. DOI: 10.1177/1756284820959245
  • Kasper D, Fauci A, Hauser S, Longo D, Jameson, J. Larry Loscalzo J. Harrison. Principios de medicina interna. Vol. 2, 19 ed. México D.F: McGRAW HIL, editor.; 2016. 1947-1964 p.
  • Kopylov U, Hanzel J, Liefferinckx C, De Marco D, Imperatore N, Plevris N, et al. Effectiveness of dose escalation in Crohn’s disease patients with insufficient response to standard-dose subcutaneous us-tekinumab maintenance therapy: A multicentre international cohort study. J Crohns Colitis. January 2020; 14:S111–S111. DOI: 10.1093/ecco-jcc/jjz203.113
  • Meserve J, Ma C, Dulai PS, Jairath V, Singh S. Effectiveness of Reinduction and/or Dose Escalation of Ustekinumab in Crohn’s Disease: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2021; S1542-3565(21)01084-3. DOI: 10.1016/j.cgh.2021.10.002
  • Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. DOI: 10.1371/journal.pmed1000097
  • Ollech J, Normatov I, Peleg N, Patel S, Rai V, Wang JD, et al. Effectiveness of Ustekinumab Dose Escalation in Crohn’s Disease. Gastroenterology. 2020; 158(6):S961–S961.
  • Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009) — Centre for Eviden-ce-Based Medicine (CEBM), University of Oxford [Internet]. [cited August 25, 2022]. Available at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-le-vels-of-evidence-march-2009
  • Paredes JM, Moreno-Osset E. Manejo práctico de la intensificación del tratamiento biológico en los pacientes con enfermedad inflamatoria intestinal. Enfer Inflamatoria Intest al Día. 2016; 15(3):96–103. DOI: 10.1016/j.eii.2016.04.004
  • Sandborn WJ, Gasink C, Gao LL, Blank MA, Johanns J, Guzzo C, et al. Ustekinumab induction and maintenance therapy in refractory Crohn’s disease. N Engl J Med. 2012; 367(16):1519–28. DOI: 10.1056/NEJMoa1203572
  • Srinivasan A, De Cruz P, van Langenberg DR. Ustekinumab dose intensification for loss of response-should we reinduce before shortening the dose interval? Aliment Pharmacol Ther. 2020; 52(3):564–5. DOI: 10.1111/apt.15883
  • Thomann AK, Schulte LA, Globig AM, Hoffmann P, Klag T, Itzel T, et al. Ustekinumab serum concen-trations are associated with clinical outcomes in Crohn’s disease - a regional multi-center pilot study. Z Gastroenterol. 2020; 58(5):439–44. DOI: 10.1055/a-1088-1461
  • Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. PLoS Med 2007; 4: e296. DOI: 10.1371/journal.pmed.0040296