Ustekinumab for Perianal Crohn's Disease: The BioLAP Multicenter Study From the GETAID.
Abscess
Adolescent
Adult
Aged
Anti-Inflammatory Agents
/ therapeutic use
Antibodies, Monoclonal, Humanized
/ therapeutic use
Anus Diseases
/ drug therapy
Cohort Studies
Crohn Disease
/ drug therapy
Disease-Free Survival
Female
Gastrointestinal Agents
/ therapeutic use
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Rectal Fistula
/ drug therapy
Retrospective Studies
Treatment Failure
Treatment Outcome
Tumor Necrosis Factor Inhibitors
/ therapeutic use
Ustekinumab
/ therapeutic use
Young Adult
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
entrez:
6
11
2020
pubmed:
7
11
2020
medline:
15
12
2020
Statut:
ppublish
Résumé
New therapeutic options for patients with Crohn's disease (CD) with perianal lesions failing anti-tumor necrosis factor (TNF) agents are needed. We aimed to assess the effectiveness of ustekinumab in perianal CD (pCD) and predictors of clinical success in a real-life multicenter cohort. We conducted a national multicenter retrospective cohort study in patients with either active or inactive pCD who received ustekinumab. In patients with active pCD at treatment initiation, the success of ustekinumab was defined by clinical success at 6 months assessed by the physician's judgment without additional medical or surgical treatment for pCD. Univariate and multivariable logistic regression analyses were performed to identify predictors of success. In patients with inactive pCD at ustekinumab initiation, the pCD recurrence-free survival was calculated using the Kaplan-Meier method. Two hundred seven patients were included, the mean age was 37.7 years, the mean duration of CD was 14.3 years, and the mean number of prior perianal surgeries was 2.8. Two hundred five (99%) patients had previously been exposed to at least 1 anti-TNF and 58 (28%) to vedolizumab. The median follow-up time was 48 weeks; 56/207 (27%) patients discontinued therapy after a median time of 43 weeks. In patients with active pCD, success was reached in 57/148 (38.5%) patients. Among patients with setons at initiation, 29/88 (33%) had a successful removal. The absence of optimization was associated with treatment success (P = 0.044, odds ratio 2.74; 95% confidence interval: 0.96-7.82). In multivariable analysis, the number of prior anti-TNF agents (≥3) was borderline significant (P = 0.056, odds ratio 0.4; 95% confidence interval: 0.15-1.08). In patients with inactive pCD at initiation, the probability of recurrence-free survival was 86.2% and 75.1% at weeks 26 and 52, respectively. Ustekinumab appears as a potential effective therapeutic option in perianal refractory CD. Further prospective studies are warranted.
Identifiants
pubmed: 33156100
doi: 10.14309/ajg.0000000000000810
pii: 00000434-202011000-00016
doi:
Substances chimiques
Anti-Inflammatory Agents
0
Antibodies, Monoclonal, Humanized
0
Gastrointestinal Agents
0
Tumor Necrosis Factor Inhibitors
0
vedolizumab
9RV78Q2002
Ustekinumab
FU77B4U5Z0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1812-1820Références
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