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Meta-Analysis
. 2022 Dec;20(12):2728-2740.e1.
doi: 10.1016/j.cgh.2021.10.002. Epub 2021 Oct 8.

Effectiveness of Reinduction and/or Dose Escalation of Ustekinumab in Crohn's Disease: A Systematic Review and Meta-analysis

Joseph Meserve  1 , Christopher Ma  2 , Parambir S Dulai  1 , Vipul Jairath  3 , Siddharth Singh  4
Affiliations
Meta-Analysis

Effectiveness of Reinduction and/or Dose Escalation of Ustekinumab in Crohn's Disease: A Systematic Review and Meta-analysis

Joseph Meserve et al. Clin Gastroenterol Hepatol. 2022 Dec.

Abstract

Background & aims: Patients with Crohn's disease (CD) treated with ustekinumab who experience inadequate response, or loss of response after standard induction and/or maintenance dosing may benefit from dose escalation. We conducted a systematic review and meta-analysis examining the effectiveness of reinduction and/or dose interval shortening of ustekinumab in patients with active CD despite standard induction and maintenance.

Methods: Through a systematic literature search through March 31, 2021, we identified 15 cohort studies in 925 adults with CD with inadequate response or loss of response to standard dose ustekinumab, underwent dose escalation (reinduction and/or dose interval shortening to <8 weeks), and reported rates of achieving clinical response, corticosteroid-free clinical remission, endoscopic response, and/or remission. We calculated pooled rates (with 95% confidence intervals) using random effects meta-analysis and examined factors associated with response to dose escalation through qualitative synthesis of individual studies.

Results: On meta-analysis, 55% of patients (95% confidence interval, 52%-58%) with inadequate response or loss of response who underwent ustekinumab dose escalation achieved clinical response, with moderate heterogeneity (I2 = 57%). Approximately 61% of patients were able to achieve endoscopic response, including 29% who achieved endoscopic remission. Dose interval shortening alone recaptured response in 57% patients. No consistent factors associated with response to dose escalation were identified on qualitative synthesis.

Conclusion: In real word settings, ustekinumab dose escalation was effective in achieving response in patients with CD with inadequate response, or loss of response to standard dose induction and/or maintenance therapy.

Keywords: Biologics; Dose Adjustment; Pharmacokinetics; Therapeutic Drug Monitoring.

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Figures

Figure 1.
Figure 1.
Study selection flowchart
Figure 2.
Figure 2.
Pooled rate of clinical response with (A) dose escalation (reinduction and/or dose-interval shortening), or (B) maintenance dose-interval shortening of ustekinumab.
Figure 3.
Figure 3.
Pooled rate of corticosteroid-free clinical remission with maintenance dose-interval shortening of ustekinumab.
Figure 4.
Figure 4.
Pooled rate of (A) endoscopic response and (B) endoscopic remission, with dose escalation of ustekinumab.
Figure 4.
Figure 4.
Pooled rate of (A) endoscopic response and (B) endoscopic remission, with dose escalation of ustekinumab.
eFigure 1.
eFigure 1.
Pooled rate of biochemical remission with dose escalation of ustekinumab
See this image and copyright information in PMC

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