P684 Extra intravenous reinduction of ustekinumab on an already shortening interval is an effective optimisation strategy for patients with refractory Crohn’s disease
Yao, J.(1)*;Liu, T.(1);Min, Z.(1);
(1)The Sixth Affiliated Hospital of Sun Yat-Sen University, Department of Gastroenterology- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China;
Background
Designing treatment optimisation strategy for ustekinumab (UST) is challenging. We aimed to evaluate the efficacy and safety of extra weight-based intravenous reinduction of UST on an already shortening interval in patients with refractory Crohn’s disease (CD). To the best of our knowledge, this is the first study to report optimised UST treatment in a Chinese population.
Methods
This was a single-center retrospective observational study. Dosing optimisation strategies were designed for CD patients showing partial or loss of response to standardised UST with a shortened interval of every-8-week (q8w) dosing, or an extra weight-based intravenous reinduction followed by q8w subcutaneous administration. Clinical, biochemical, and endoscopic findings and trough concentrations of UST were analyzed.
Results
Dose optimisation strategies were developed for 27 out of 64 patients; 13 patients required a shortened q8w interval and 14 patients required intravenous reinduction. Crohn’s disease activity index [96.5 (39.8,156.3) vs. 158.0 (101.5,175.3), P=0.009] and C-reactive protein [3.3 (1.1,7.0) vs. 4.8 (0.5,15.1), P=0.023] levels decreased significantly after intravenous reinduction, while the trough concentration of UST increased [1.8 (1.2,8.6) vs. 1.1 (0.2, 6.4), P=0.009]. Clinical and endoscopic remission was achieved in 57.1% (8/14) and 33.3% (2/3) of patients, respectively, while 53.8% (7/13) and 25.0% (2/8) of patients achieved clinical and endoscopic remission at around week 8 in the q8w cohort, respectively. The incidence of patient-reported adverse effects was 3.7%. (Figure 1)
Conclusion
Intravenous reinduction improved clinical and endoscopic remission safely and effectively in patients showing poor response to standardised UST treatment, which should be an optimal rescue optimisation strategy before switching to biologics targeting other pathways.