P438 Reinduction with ustekinumab in Crohn’s disease patients with a loss of response to treatment
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".