P438 Reinduction with ustekinumab in Crohn’s disease patients with a loss of response to treatment
Notice bibliographique
Résumé
Ustekinumab (UST), an inhibitor of IL-12 and IL-23, has been shown to effectively induce and maintain remission in patients with Crohn’s disease. However, a significant number of patients do not respond or experience a secondary loss of response to UST. This study aims to assess the role of UST reinduction to achieve clinical and endoscopic response in patients with active Crohn’s disease on UST maintenance therapy. In this retrospective, observational study, patients experiencing a partial response or a secondary loss of response to UST based on clinical and/or endoscopic criteria received intravenous or subcutaneous reinduction of UST. Post-reinduction, clinical remission was defined as an HBI <5 off corticosteroids, endoscopic remission was defined as a SES-CD score of <3 and endoscopic response was defined as a decrease in the SES-CD ≥50%. Adequate drug concentrations were defined as a UST level of ≥1 μg/ml. Twelve reinductions were performed in 11 patients between February 2016 and June 2017. Three reinductions were performed for clinical non-response, 6 for active disease on endoscopy or imaging, and 3 for both these indications. All patients had received their first induction subcutaneously at a dose of either 90 mg at Weeks 0, 1 and 2 (n = 7) or of 270, 180, and 180 mg at Weeks 0, 1, and 2 (n = 4). All were on a maintenance dose of UST 90 mg every 4 weeks, with the exception of one who had a 16-week drug holiday prior to reinduction. The median duration of UST treatment prior to reinduction was 16 months (interquartile ratio [IQR]: 12–32). Eight reinduction doses (67%) were administered intravenously at a dose of 260 mg (n = 2) or 390 mg (n = 6) based on weight, while the remaining 4 (33%) were administered subcutaneously (90 mg every week for three doses (n = 1), or 270–180–180 mg at Weeks 0, 1, and 2 (n = 3)). Clinical follow-up occurred at a mean of 2 ± 0.8 months post-reinduction, while follow-up endoscopy or imaging was performed at a mean of 7 ± 4 months. Five of nine patients (55.5%) achieved endoscopic response (n = 4) or remission (n = 1), while four of six patients (66.7%) achieved clinical remission. Overall, 62.5% of patients who received IV reinduction (n = 8) were in clinical remission or endoscopic response at follow-up. Therapeutic drug monitoring for UST was performed in five patients prior to reinduction, all of whom had a UST level >1 μg/ml (median 5.5, IQR: 5.4–6.99), and three of these patients (60%) achieved clinical remission or endoscopic response. No serious adverse events were reported following reinduction. Ustekinumab reinduction can be used safely to induce clinical and endoscopic response in patients with active Crohn’s disease, even in the context of previously defined adequate UST drug concentrations.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».