Assuntos
Humanos , Feminino , Adulto , Doença de Crohn/complicações , Doença de Crohn/patologia , Baço/cirurgia , EsplenectomiaRESUMO
Both psoriasis and inflammatory bowel disease (IBD) are immunomediated diseases. Some of their therapeutic tools are monoclonal antibodies. Ixekizumab is an interleukin-17 (IL-17) inhibitor approved for the treatment of psoriasis. Cases of IBD onset have been reported in patients treated with this drug. We present the case of a 35-year-old patient with the onset of ulcerative colitis (UC) type of IBD after starting ixekizumab treatment.
RESUMO
Background: ustekinumab has proven effective in Crohns disease (CD). However, some patients will partially respond or lose response over time. Data supporting the effectiveness of dose escalation in this scenario is scarce. Aim: to evaluate the effectiveness of ustekinumab dose escalation in CD. Methods: patients with active CD (Harvey-Bradshaw ≥ 5) who had received intravenous (IV) induction and at least a subcutaneous (SC) dose were included in this retrospective observational study. Ustekinumab dose was escalated, either via shortening of the interval to six or four weeks or IV reinduction plus shortening to every four weeks. Results: ninety-one patients were included, and ustekinumab dose was escalated after a median of 35 weeks of treatment. At week 16 after intensification, steroid-free clinical response and remission were observed in 62.6 % and 25.3 % of patients, respectively. Systemic corticosteroids were discontinued in 46.7 % of patients who were on corticosteroids at baseline. Follow-up data beyond week 16 were available for 78 % of patients; at the last visit, 66.2 % and 43.7 % were in steroid-free clinical response and remission, respectively. After a median follow-up of 64 weeks, 81 % of patients were still treated with ustekinumab. Adverse events were reported in 4.3 % of patients; these were all mild and did not lead to hospitalization or discontinuation of treatment. Five patients (5.5 %) underwent surgical resection, with no immediate postsurgical complications. Conclusion: ustekinumab dose escalation was effective in recapturing response in over half of the patients. These findings suggest that dose escalation should be considered in patients who experience loss or partial response to the standard maintenance.(AU)
Assuntos
Humanos , Masculino , Feminino , Ustekinumab/administração & dosagem , Doença de Crohn/tratamento farmacológico , Resultado do Tratamento , Dose Máxima Tolerável , Dosagem , Gastroenteropatias/classificação , Gastroenteropatias/diagnóstico , Doença de Crohn/diagnósticoRESUMO
BACKGROUND: ustekinumab has proven effective in Crohn's disease (CD). However, some patients will partially respond or lose response over time. Data supporting the effectiveness of dose escalation in this scenario is scarce. AIM: to evaluate the effectiveness of ustekinumab dose escalation in CD. METHODS: patients with active CD (Harvey-Bradshaw ≥ 5) who had received intravenous (IV) induction and at least a subcutaneous (SC) dose were included in this retrospective observational study. Ustekinumab dose was escalated, either via shortening of the interval to six or four weeks or IV reinduction plus shortening to every four weeks. RESULTS: ninety-one patients were included, and ustekinumab dose was escalated after a median of 35 weeks of treatment. At week 16 after intensification, steroid-free clinical response and remission were observed in 62.6 % and 25.3 % of patients, respectively. Systemic corticosteroids were discontinued in 46.7 % of patients who were on corticosteroids at baseline. Follow-up data beyond week 16 were available for 78 % of patients; at the last visit, 66.2 % and 43.7 % were in steroid-free clinical response and remission, respectively. After a median follow-up of 64 weeks, 81 % of patients were still treated with ustekinumab. Adverse events were reported in 4.3 % of patients; these were all mild and did not lead to hospitalization or discontinuation of treatment. Five patients (5.5 %) underwent surgical resection, with no immediate postsurgical complications. CONCLUSION: ustekinumab dose escalation was effective in recapturing response in over half of the patients. These findings suggest that dose escalation should be considered in patients who experience loss or partial response to the standard maintenance.
Assuntos
Doença de Crohn , Ustekinumab , Humanos , Ustekinumab/efeitos adversos , Doença de Crohn/tratamento farmacológico , Indução de Remissão , Estudos Retrospectivos , Corticosteroides/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: tofacitinib is a Janus kinase inhibitor approved for the treatment of moderate-severe ulcerative colitis (UC). This study aimed to evaluate its efficacy in a real-life setting. METHODS: a retrospective and multicenter observational study was performed with UC patients treated with tofacitinib. Short and long-term treatment effectiveness, treatment survival, need for dose escalation and safety were analyzed. Clinical response and remission were defined in accordance with the partial Mayo score. RESULTS: seventy-four patients were included, 98.3 % had received prior biological treatment, 55.4 % with three or more biologicals and up to 64.9% with two or three different mechanisms of action. Clinical remission and response rates were 37.8 % and 77 % at eight weeks, and 41.8 % and 70.1 % at 16 weeks. With regard to non-responders at eight weeks, 37.5 % achieved a delayed clinical response at 16 weeks. Mean treatment duration was 19 months (95 % CI: 16-22), with a treatment survival of 56 % at 28 months, and remission and response rates at 24 months of 53.8 % and 61.5 %. Twenty-three treatments were withdrawn, most of them (18) during the induction period. There were adverse events in a quarter of the patients; only four were severe and led to treatment discontinuation. CONCLUSION: tofacitinib has a demonstrated efficacy in clinical practice to induce and maintain clinical response in treatment-refractory UC patients, with an acceptable safety profile.
Assuntos
Colite Ulcerativa , Colite Ulcerativa/induzido quimicamente , Colite Ulcerativa/tratamento farmacológico , Humanos , Piperidinas/efeitos adversos , Pirimidinas/efeitos adversos , Estudos RetrospectivosAssuntos
Varizes Esofágicas e Gástricas , Síndrome da Veia Cava Superior , Varizes , Varizes Esofágicas e Gástricas/complicações , Hemorragia , Humanos , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Varizes/complicações , Varizes/diagnóstico por imagemAssuntos
Pancreatite , Doenças Vasculares , Doença Aguda , Humanos , Pâncreas , Pancreatite/etiologiaRESUMO
No disponible
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Humanos , Masculino , Pessoa de Meia-Idade , Imunoterapia/métodos , Colite Ulcerativa/diagnóstico , Colite/induzido quimicamente , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Melanoma/secundário , Fatores Imunológicos/efeitos adversos , Diagnóstico Diferencial , Colite/tratamento farmacológico , Corticosteroides/uso terapêutico , Enterocolite/induzido quimicamenteAssuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Colite/induzido quimicamente , Neoplasias Ósseas/secundário , Colite/diagnóstico por imagem , Colite/tratamento farmacológico , Colite Ulcerativa/diagnóstico por imagem , Colonoscopia , Humanos , Neoplasias Pulmonares/secundário , Masculino , Melanoma/tratamento farmacológico , Melanoma/secundário , Pessoa de Meia-Idade , Neoplasias Cutâneas/tratamento farmacológicoAssuntos
Neoplasias Colorretais/genética , Genes BRCA1 , Doenças Inflamatórias Intestinais/genética , Síndromes Neoplásicas Hereditárias/genética , Adenocarcinoma/genética , Adenocarcinoma/cirurgia , Adulto , Idade de Início , Anti-Inflamatórios/uso terapêutico , Azatioprina/uso terapêutico , Neoplasias da Mama/genética , Colite Ulcerativa/genética , Neoplasias do Colo/genética , Neoplasias do Colo/cirurgia , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Mesalamina/uso terapêutico , Proctocolectomia RestauradoraRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Doenças Cerebelares/complicações , Doenças Cerebelares/diagnóstico por imagem , Diplopia/complicações , Neurossífilis/complicações , Autoimunidade/efeitos dos fármacos , Metilprednisolona/uso terapêutico , Imageamento por Ressonância Magnética , Cabeça/diagnóstico por imagem , Anticorpos Antinucleares/análise , Imunossupressores/uso terapêuticoAssuntos
Doenças Autoimunes do Sistema Nervoso/etiologia , Doenças Cerebelares/etiologia , Doença de Crohn/complicações , Doença Aguda , Adulto , Anticorpos Antinucleares/sangue , Doenças Autoimunes do Sistema Nervoso/diagnóstico por imagem , Doenças Autoimunes do Sistema Nervoso/imunologia , Ataxia Cerebelar/etiologia , Doenças Cerebelares/diagnóstico por imagem , Doenças Cerebelares/imunologia , Doença de Crohn/imunologia , Diplopia/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neuroimagem , Reflexo Anormal , Tomografia Computadorizada por Raios XRESUMO
No disponible