96 Four-Weekly Ustekinumab is Effective in Crohn’s Disease Patients With Suboptimal Response to Standard Dosing: A Single-Centre Experience
Bibliographic record
Abstract
Background: Ustekinumab, an anti-IL12/23 monoclonal antibody, is licensed for moderate-to-severe Crohn’s disease (CD) using an intravenous induction dose followed by 90 mg subcutaneously every 8–12 weeks. Dose interval reduction to every 4 weeks has shown promise in small studies, but real-world data remain limited. Methods: We performed a retrospective review of CD patients at Frimley Health NHS Foundation Trust who underwent ustekinumab dose escalation from every 8 weeks to every 4 weeks between December 2019 and January 2024. Escalation was approved via individual funding requests for patients with only partial response to standard dosing. Disease activity was assessed using one or more of the following: small bowel imaging [MR enterography with GIQuant or bowel ultrasound], colonoscopy [SES-CD], C-reactive protein (CRP), faecal calprotectin (FCP), and patient-reported outcomes. Results: Twenty-three patients (57% female; median age 47 years, IQR 34–64) underwent dose escalation. Montreal classification: L1 35%, L2 9%, L3 57%, and 22% with perianal disease. The median time to escalation was 16 months (IQR 12–27). Overall, 21/23 (91%) demonstrated improvement in ≥1 disease parameter. Radiology at 12 months (n = 21): 67% improved, 24% stable, 10% worsened; 83% of those with paired GIQuant scores improved (median 76 to 119). CRP (n = 23): 70% improved (median 5.8 to 3.6). FCP (n = 10): 80% improved (median 646 to 184). Endoscopy (n = 2): both improved SES-CD (29 to 15; 9 to 0, respectively). Patient-reported outcomes (n = 22): 55% reported improvement, 36% remained unchanged, and 9% were persistently asymptomatic. No adverse events were recorded during the study period. Conclusions: In this real-world cohort, interval reduction of ustekinumab to every 4 weeks was associated with meaningful improvements in objective and patient-reported outcomes in the majority of patients with suboptimal response to standard dosing. With the advent of biosimilar ustekinumab, interval escalation should be considered a viable and cost-conscious alternative to biologic switching in selected CD patients.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".