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Meta-Analysis
. 2025;34(3):226-237.
doi: 10.1159/000543831. Epub 2025 Feb 3.

Efficacy of Dose Escalation of Ustekinumab in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Mohammad Ebad Ur Rehman  1 , Ammara Tahir  2 , Amna Hussain  2 , Aizaz Ali  3 , Abu Huraira Bin Gulzar  4 , Abdul Qadeer Khan  5 , Maha Sajjad  6 , Fatima Shahid  1 , Shahroon Zahid  7 , Ummara Aslam  5 , Talha Bin Yasin  8 , Aqsa Bilal  9 , Tehreem Fatima  10 , Muhammad Sheraz Hameed  1 , Tehseen Haider  1 , Sajeel Saeed  1 , Abdulqadir J Nashwan  11   12
Affiliations
Meta-Analysis

Efficacy of Dose Escalation of Ustekinumab in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Mohammad Ebad Ur Rehman et al. Med Princ Pract. 2025.

Abstract

Background: Ustekinumab is an effective drug in the treatment of inflammatory bowel disease (IBD), but inadequate response or loss of response is reported in several patients. Dose escalation by intravenous reinduction or interval shortening may be a suitable option to recapture response. We undertook a systematic review and meta-analysis to assess the efficacy of dose escalation in IBD patients receiving ustekinumab.

Methods: A systematic literature search was conducted on PubMed, Embase, Clinicaltrails.gov, and Cochrane from inception to June 1, 2024. We conducted a proportional meta-analysis on MetaXL. Our primary outcomes were clinical response and clinical remission.

Results: Twenty-eight articles were included (n = 2,129 patients). Eighteen studies (692 patients out of 1,218) reported clinical response, with pooled prevalence of 55% (95% CI: 46-65%). Out of 1,041 patients, 524 showed clinical remission with pooled prevalence of 51% (95% CI: 42-59%).

Conclusion: This systematic review and meta-analysis showcased promising results, in terms of clinical response and remission, in IBD patients receiving dose escalation of ustekinumab.

Keywords: Crohn’s disease; Inflammatory bowel disease; Monoclonal antibodies; Ulcerative colitis.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1.
Fig. 1.
PRISMA flowchart highlighting the literature search and study selection process.
Fig. 2.
Fig. 2.
Clinical Response: 55% of IBD patients achieved clinical response after UST Dose Intensification.
Fig. 3.
Fig. 3.
Clinical Remission: 51% of IBD patients achieved clinical remission after UST Dose Intensification.
See this image and copyright information in PMC

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