scholarly journals A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Seema Rajani ◽  
Hien Q. Huynh ◽  
Leanne Shirton ◽  
Cheryl Kluthe ◽  
Donald Spady ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Fractional Excretion ◽  
Fecal Calprotectin ◽  
Mucosal Inflammation ◽  
Diagnostic Strategy ◽  
Mucosal Disease ◽  
One Year ◽  
Hla Haplotypes ◽  
Gastrointestinal Permeability

Background. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition endorses serological diagnosis (SD) for pediatric celiac disease (CD). The objective of this study was to pilot SD and to prospectively evaluate gastrointestinal permeability and mucosal inflammation at diagnosis and after one year on the gluten-free diet (GFD). We hypothesized that SD would be associated with similar short term outcomes as ED.Method. Children, 3–17 years of age, referred for possible CD were eligible for SD given aTTG level ≥200 U/mL, confirmed by repeat aTTG and HLA haplotypes. Gastrointestinal permeability, assessed using sugar probes, and inflammation, assessed using fecal calprotectin (FC), at baseline and after one year on a GFD were compared to patients who had ED.Results. Enrolled SD (n=40) and ED (n=48) patients had similar demographics. ED and SD groups were not different in baseline lactulose: mannitol ratio (L : M) (0.049 versus 0.034;p=0.07), fractional excretion of sucrose (%FES; 0.086 versus 0.092;p=0.44), or fecal calprotectin (FC; 89.6 versus 51.4;p=0.05). At follow-up, urine permeability improved and was similar between groups, L : M (0.022 versus 0.025;p=0.55) and %FES (0.040 versus 0.047;p=0.87) (p>0.05). FC improved but remained higher in the SD group (37.1 versus 15.9;p=0.04).Conclusion. Patients on the GFD showed improved intestinal permeability and mucosal inflammation regardless of diagnostic strategy. This prospective study supports that children diagnosed by SD have resolving mucosal disease early after commencing a GFD.

scholarly journals Evaluation of efficacy and comparative frequency of adverse events in patients with ulcerative colitis receiving the original infliximab and its biosimilar. One year of observation

2019 ◽  
Vol 91 (8) ◽  
pp. 41-46
Author(s):  
O V Knyazev ◽  
T V Shkurko ◽  
A V Kagramanova ◽  
A A Lishchinskaya ◽  
M Yu Zvyaglova ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Adverse Events ◽  
Real Life ◽  
Fecal Calprotectin ◽  
Biologic Drugs ◽  
Real Life Data ◽  
Bowel Diseases ◽  
Significant Clinical Improvement ◽  
One Year

Real - life data on the effectiveness and safety of biosimilar and biologic drugs licensed for treatment of inflammatory bowel diseases (IBD) is lacking. Aim. To investigate efficacy of original Infliximab (IFX) and its biosimilar in treating patients with ulcerative colitis (UC) and determine the frequency of adverse events during 1 year follow - up period. Materials and methods. Our cohort consisted of 98 ulcerative colitis patients, treated with original IFX and its biosimilar since December 2017 till December 2018 years. Original Infliximab was prescribed in 56 UC patients (57.1%) during 5 years and longer; 16 patients (16.3%) were switched to IFX biosimilar; 13 UC bio - naïve patients (13.3%) received original IFX, 29 (29.6%) patients - biosimilar IFX. In 14 patients (14.3%) original infliximab was rotated with biosimilar. We picked out 42 patients to assess efficacy of original IFX and biosimilar. Results and discussion. Twelve patients, received original IFX and 28 patients, treated with its biosimilar, showed significant clinical improvement by decreasing Mayo index from 9.7±0.4 and 10.2±0.2 points to 1.9±0.09 and 2.1±0.1 points, accordingly. Also we noticed positive change in laboratory markers - CRP decrease from 89.6±8.7 mg/l and 77.5±8.0 mg/l to 6.5±0.8 mg/l and 6.9±0.8 mg/l (p>0.05), albumin increase from 30.1±4.7 g/l and 29.6±3.6 g/l to 34.1±6.3 g/l and 32.8±5.9 g/l (p>0.05), increase of serum iron levels from 6.4±0.5 mcg/l and 7.1±0.65 mcg/l to 14.6±4.4 mcg/l and 15.9±5.1 mcg/l (p>0.05), hemoglobin increase from 104.7±9.8 g/l and 102.2±8.8 g/l till 124±11.3 g/l and 121±10.9 g/l (p>0.05), and fecal calprotectin decrease from 1680±134 mcg/g and 1720±126 mcg/g till 245.5±33.4 mcg/g and 230.5±29.8 mcg/g (p>0.05). During 1 year follow - up 12 UC patients, treated with original IFX and its biosimilar, developed adverse events. The majority of adverse events (n=8) were registered in patients, rotating administration of original IFX and its biosimilar. Conclusion. IFX biosimilar is effective as well as original IFX. Frequency of adverse events, occurred in patients, treated with original IFX, was comparable with adverse events frequency in patients, received biosimilar IFX. Frequency of adverse events was significantly higher in UC patients, rotating original IFX and its biosimilar.

scholarly journals P552 Assessing adherence to objective disease monitoring and outcomes with adalimumab in a real-world IBD cohort

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S519-S519
Author(s):  
Y Xiao ◽  
A Al Khoury ◽  
P Golovics ◽  
R Kohen ◽  
W Afif ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Symptoms ◽  
Fecal Calprotectin ◽  
Dose Optimization ◽  
Early Assessment ◽  
Mayo Score ◽  
Objective Monitoring ◽  
Kaplan Meier ◽  
One Year

Abstract Background Data suggests that tight objective monitoring may improve clinical outcomes in IBD. Methods The aim of this study is to assess the adherence to serial tight objective monitoring(clinical and biomarkers) and its effect on clinical outcomes. We retrospectively reviewed the chart of 428 consecutive IBD patients started on adalimumab between January 1,2015–January 1,2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index, partial Mayo score), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) assessments were captured at treatment initiation and at 3, 6, 9, and 12 months. Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method Results Clinical evaluation was available in nearly all patients at 3(CD-UC:95-94%), 6(90-83%), 9(86-85%) and 12(96-89%) months. CRP was also available in nearly all patients but testing frequency decreased in CD patients over time. Compliance to serial FCAL testing was low. Clinical remission at one-year was higher in patients adherent to early assessment visit at 3 months (p=0.001 for CD and UC). Adherence to early follow-up resulted in earlier dose optimisation in CD and UC patients (pLogrank=0.026 for UC & p=0.09 for CD). Overall drug sustainability did not differ. Conclusion Clinical and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization, improved one-year clinical outcomes but did not change drug sustainability.

scholarly journals Evaluation and Management of Skeletal Health in Celiac Disease: Position Statement

2012 ◽  
Vol 26 (11) ◽  
pp. 819-829 ◽  
Author(s):  
Mona A Fouda ◽  
Aliya A Khan ◽  
Muhammad Sultan ◽  
Lorena P Rios ◽  
Karen McAssey ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Position Statement ◽  
Current Evidence ◽  
Mineral Density ◽  
High Fracture ◽  
Skeletal Health ◽  
X Ray ◽  
Increased Risk ◽  
One Year

OBJECTIVE: To review the evaluation and management of skeletal health in patients with celiac disease (CD), and to make recommendations on screening, diagnosis, treatment and follow-up of low bone mineral density (BMD) in CD patients.METHODS: A multidisciplinary team developed clinically relevant questions for review. An electronic search of the literature was conducted using the MEDLINE and EMBASE databases from 1996 to 2010. All original studies, reviews and guidelines, both pediatric and adult, were included. A document summarizing the results of the review and proposed recommendations was prepared and underwent multiple revisions until consensus was reached.RESULTS: At diagnosis, approximately one-third of adult CD patients have osteoporosis, one-third have osteopenia and one-third have normal BMD. Children with CD have low bone mass at diagnosis. Adult and pediatric CD patients are at increased risk of fractures.DISCUSSION: For adults, serum calcium, albumin, 25(OH) vitamin D3, parathyroid hormone and 24 h urine calcium testing should be performed at diagnosis; patients with ‘classic’ CD and those at risk for osteoporosis should undergo a dual x-ray absorptiometry scan. An abnormal baseline dual x-ray absorptiometry scan should be repeated one to two years after initiation of a gluten-free diet (GFD). For children, BMD should be assessed one year after diagnosis if GFD adherence is not strict. A GFD is the most important treatment for bone loss. Supplemental antiresorptives may be justified in those who remain at high fracture risk (eg, postmenopausal women, older men) after implementation of a GFD.CONCLUSION: Current evidence does not support the screening of all CD patients for low BMD at diagnosis. Follow-up BMD assessment should be performed one to two years after initiation of a GFD.

scholarly journals Induction of Remission in Pediatric Crohn’s Disease Patients Assessed by the Mucosal Inflammation Noninvasive Index

2021 ◽  
Vol 10 (23) ◽  
pp. 5613
Author(s):  
Roma Herman ◽  
Paulina Dumnicka ◽  
Stanisław Pieczarkowski ◽  
Krzysztof Fyderek
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Induction Therapy ◽  
Activity Index ◽  
Disease Activity Index ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
Mucosal Inflammation ◽  
Exclusive Enteral Nutrition

Mucosal healing (MH) is the main therapeutic goal of Crohn’s disease (CD). The Mucosal Inflammation Noninvasive Index (MINI) appears to be a promising tool for distinguishing MH from its inflammation. This study aims to evaluate MINI in monitoring remissions induced by exclusive enteral nutrition (EEN) in pediatric CD patients. Out of 55 newly diagnosed CD children, 31 who completed 6–8 weeks of EEN were analyzed. Clinical and biochemical data, activity of CD assessed with the Pediatric Crohn’s Disease Activity Index (PCDAI) and MINI were compared within seven days pre- and post-EEN. Response to induction therapy was defined as a decrease of PCDAI by >12.5 points. The follow-up was performed up to 12 months after EEN termination. Out of 31 children who completed 6–8 weeks of EEN, eight required corticosteroids in addition to EEN. Twenty-four patients (77%) responded to induction therapy. In responders, MINI decreased from 19 (Q1:17; Q3:22) to 12 (Q1:6; Q3:14), p < 0.001. The diagnostic accuracy of post-EEN MINI and post-EEN fecal calprotectin (FC) for treatment failure were AUC: 0.899 (95%CI: 0.737–1.000) and 0.762 (95%CI: 0.570–0.954), respectively. In the follow-up of 25 patients (80.6%), the post-EEN MINI of ≥13 points predicted CD relapse (87.5% sensitivity; 64.7% specificity), while FC had no prognostic value. MINI allows for monitoring of EEN and is superior in predicting disease relapse to FC.

scholarly journals Dietary Compliance and Quality of Life in Celiac Disease: A Long-Term Follow-Up of Primary School Screening-Detected Patients

2021 ◽  
Vol 9 ◽  
Author(s):  
Donatella Iorfida ◽  
Francesco Valitutti ◽  
Annarita Vestri ◽  
Arianna Di Rocco ◽  
Salvatore Cucchiara ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Celiac Disease ◽  
Screening Strategy ◽  
Diagnostic Strategy ◽  
Dietary Compliance ◽  
Screening Programs ◽  
Referral Center ◽  
Significant Difference

Background: Whether the diagnostic approach for celiac disease (CD) can really affect quality of life (QoL) and dietary compliance remains controversial.Aims: This study aimed to evaluate QoL and compliance to gluten-free diet (GFD) in adolescents/young adults diagnosed with CD through a screening strategy during childhood compared to age-matched CD patients diagnosed by case-finding and to assess whether follow-up at a referral center for CD influences compliance and QoL.Materials and Methods: Thirty-seven CD patients who were diagnosed by screening programs (SC-group) and 38 age-matched CD patients diagnosed due to symptoms (CF-group) were enrolled. Patients were asked to answer a questionnaire on QoL, dietary compliance, and follow-up care for CD.Results: Twenty-nine patients of the SC-group (median age 18.0 years, interquartile range [IQR] 16.0–19.0) and 31 patients of the CF-group (median age 17.0 years, IQR 15.5–18.0) completed the questionnaire. No significant difference relating adherence to the GFD and QoL was shown between the two groups. The majority (93.5%) of CF-group regularly had annual follow-up at a referral center compared to 37.9% of the SC-group (p &lt; 0.001).Conclusion: The diagnostic strategy does not seem to impact QoL and dietary compliance. However, implementation of follow-up might still be necessary for patients identified through screening.

scholarly journals Frequency of autoimmune thyroiditis in children with Celiac disease and effect of gluten free diet

2020 ◽  
Vol 36 (6) ◽  
Author(s):  
Javaria Rasheed ◽  
Rushan Hassan ◽  
Muhammad Khalid ◽  
Fauzia Zafar
Keyword(s):  
Celiac Disease ◽  
Autoimmune Thyroiditis ◽  
Prospective Observational Study ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Creative Commons ◽  
Euthyroid Status ◽  
One Year ◽  
Open Access Article

Objective: To determine the frequency of autoimmune thyroiditis in children with Celiac disease and the effect of gluten free diet on autoimmune thyroiditis. Methods: We enrolled 100 patients, age 1-12 years of either gender diagnosed as Celiac disease (CD) in this prospective observational study in the Department of Pediatric Medicine, from 1st January 2018 to 30th June 2019. Diagnosis of autoimmune thyroiditis was made if anti–thyroperoxidase >35 iu/ml or anti–thyroglobulin >20 iu/ml at diagnosis of CD and then at one year on gluten free diet (GFD) in all cases. Children with repeat anti-tTG levels > 10 times upper limit normal at 6-months after enrollment were labelled as non-compliant to GFD. Descriptive statistics were used to analyze the data. Results: Mean age of the participants was 5.94±3.16 years and 53% were females. Fourteen cases of autoimmune thyroiditis were detected at enrollment and six (7%, n/N = 6/86) were later diagnosed on follow-up who were initially negative. Seven hypothyroid cases among the autoimmune thyroiditis were treated with thyroxine and became euthyroid on follow-up testing. Compliance to GFD was 52%. Autoimmune thyroiditis improved on gluten free diet in four cases (28.6%). Of the six euthyroid cases at diagnosis three cases became hypothyroid and all were non-compliant. Conclusion: Frequency of autoimmune thyroiditis was 20% over a follow-up period of one year. Good compliance with the GFD has some effect on improving autoimmune thyroiditis and maintaining euthyroid status of CD patients. doi: https://doi.org/10.12669/pjms.36.6.2226 How to cite this:Rasheed J, Hassan R, Khalid M, Zafar F. Frequency of autoimmune thyroiditis in children with Celiac disease and effect of gluten free diet . Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2226 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Fecal Calprotectin: A Reliable Predictor of Mucosal Healing after Treatment for Active Ulcerative Colitis

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Vendel Kristensen ◽  
Arne Røseth ◽  
Tahir Ahmad ◽  
Viggo Skar ◽  
Bjørn Moum
Keyword(s):  
Ulcerative Colitis ◽  
Medical Treatment ◽  
Flexible Sigmoidoscopy ◽  
Activity Index ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
Mucosal Inflammation ◽  
Active Ulcerative Colitis ◽  
Reliable Marker

Objectives. Mucosal healing has become the new goal of treatment in ulcerative colitis. Fecal calprotectin has been demonstrated to differentiate between mucosal inflammation and mucosal healing. With this project, we investigated whether a reduction in f-calprotectin to <250 μg/g after medical treatment for active ulcerative colitis could predict mucosal healing. Material and Methods. After a baseline colonoscopy, 20 patients with active ulcerative colitis were followed with consecutive fecal calprotectin monthly until two measurements of fecal calprotectin < 250 μg/g or a maximum follow-up of 12 months. A flexible sigmoidoscopy was then performed and Mayo endoscopic subscore was used to evaluate degree of inflammation. Simple Clinical Colitis Activity Index was used for evaluation of clinical disease activity. Results. A total of 16 patients achieved fecal calprotectin < 250 μg/g during follow-up, and all 16 patients had endoscopic mucosal healing (Mayo endoscopic subscore of ≤1) on the second endoscopy. The remaining four patients had persistently high f-calprotectin levels before the second endoscopy with Mayo endoscopic subscore corresponding to endoscopic mucosal healing in three out of four patients. Conclusions. Fecal calprotectin <250 μg/g after medical treatment for active ulcerative colitis is a reliable marker of endoscopic mucosal healing.

scholarly journals A157 REAL-WORLD TIGHT OBJECTIVE MONITORING WITH ADALIMUMAB LEADS TO EARLIER DOSE OPTIMIZATION AND HIGHER CLINICAL REMISSION RATES AT 12 MONTHS.

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 163-164
Author(s):  
Y Xiao ◽  
A Al Khoury ◽  
P Golovics ◽  
R Kohen ◽  
W Afif ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Remission ◽  
Clinical Symptoms ◽  
Fecal Calprotectin ◽  
Dose Optimization ◽  
Early Assessment ◽  
Objective Monitoring ◽  
Bowel Diseases ◽  
One Year

Abstract Background Data suggests that tight objective monitoring of inflammatory bowel diseases (IBD) may improve one-year clinical outcomes. Aims The goal of this study is to assess the adherence to serial tight objective monitoring, via clinical symptoms and biomarkers, and the effect of such tight monitoring on one year outcome in IBD patients at an academic and an university-affiliated center. Methods We retrospectively reviewed the chart of 428 consecutive IBD patients who started adalimumaby at the McGill University Health Center and Jewish General Hospital (Montreal, Canada) between January 1, 2015 and January 1, 2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index and partial Mayo), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) were captured at treatment initiation and at 3, 6, 9, and 12 months. Combined adherence was defined as the evaluation of ≥2 of 3 parameters(clinical, CRP, FCAL). Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method. Results Clinical symptoms were assessed in nearly all patients at 3 (CD-UC:95-94%), 6 (90-83%), 9 (86-85%) and 12 (96-89%) months. CRP was also available for most patients but the frequency of assessment decreased in CD patients over the study period. In comparison, compliance to serial FCAL testing was low throughout the follow-up period. Clinical remission at one-year was significantly higher in patients who were adherent to early assessment visit at 3 months (p=0.001 both for CD and UC). Adherence to early follow-up also resulted in earlier dose optimisation in both CD and UC patients(pLogrank=0.026 for UC and p=0.09 for CD). However, the overall drug sustainability did not differ. Conclusions Clinical assessment and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization and improved one-year clinical outcomes but did not change drug sustainability rates. Funding Agencies None

scholarly journals Exploring Anthropometric and Laboratory Differences in Children of Varying Ethnicities with Celiac Disease

2014 ◽  
Vol 28 (7) ◽  
pp. 351-354 ◽  
Author(s):  
Seema Rajani ◽  
Abeer Alzaben ◽  
Leanne Shirton ◽  
Rabindranath Persad ◽  
Hien Q Huynh ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Ethnic Minorities ◽  
South Asian ◽  
Symptom Improvement ◽  
Minority Population ◽  
Asian Children ◽  
Group 2 ◽  
One Year ◽  
Group 1

BACKGROUND: Celiac disease (CD) is a common autoimmune disorder with an increasing prevalence, including in ethnic minorities.OBJECTIVE: To report the frequency of CD diagnosis in ethnic minorities presenting to a Canadian pediatric celiac clinic and to determine whether ethnic differences exist at diagnosis or follow-up.METHODS: Patients with biopsy-proven CD diagnosed at a multidisciplinary celiac clinic between 2008 and 2011 were identified through the clinic database. Data at referral, and six-month and 12-month follow-ups were collected. These included demographics, self-reported ethnicity, symptoms, anthropometrics and laboratory investigations, including serum immunoglobulin antitissue transglutaminase (aTTG).RESULTS: A total of 272 patients were identified; 80% (n=218) were Caucasian (group 1) and 20% (n=54) were other ethnicities. South Asians (group 2) comprised 81% (n=44) of the minority population. No differences in age or sex were found between the two groups. Group 1 patients presented more often with gastrointestinal symptoms (71% versus 43%; P<0.001), while patients in group 2 presented more often with growth concerns (21% versus 68%; P<0.001). At diagnosis, serum aTTG level was consistently lower in group 1 compared with group 2 (367 IU/mL versus 834 IU/mL; P=0.030). Both groups reported symptom improvement at six months and one year. At the end of one year, aTTG level was more likely to be normal in group 1 compared with group 2 (64% versus 29%; P<0.001).CONCLUSION: Although they represent a minority group, South Asian children comprised a significant proportion of CD patients presenting to a Canadian celiac clinic. South Asian children were more likely to present with growth concerns, which has important implications for timely diagnosis in this population. In addition, the apparent delay in normalization of aTTG levels suggests that careful follow-up and culturally focused education supports should be developed for South Asian children with CD.

scholarly journals P536 Effectiveness, safety and persistence of treatment with ustekinumab in a cohort of patients with moderate-to-severe refractory Crohn’s Disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S509-S510
Author(s):  
A I Morales Bermúdez ◽  
A M Bravo Aranda ◽  
M Martinez Burgos ◽  
R Olmedo Martín
Keyword(s):  
Clinical Remission ◽  
Real Life ◽  
Fecal Calprotectin ◽  
University Hospital ◽  
Reactive Protein ◽  
Kaplan Meier ◽  
Regional University ◽  
History Of ◽  
One Year

Abstract Background Ustekinumab has proved its efficacy and safety in moderate-to-severe Crohn′s disease (CD). However, the real practice setting differs from clinical trials. Our aim was to evaluate the effectiveness and safety of ustekinumab in a cohort of real-life practice patients with CD mostly refractory to anti-TNF α agents. Methods Observational retrospective single-center study. All patients undergoing treatment with ustekinumab at the Digestive Diseases Department of the Regional University Hospital of Málaga and at least 16 weeks of follow-up after induction were included. The primary outcome was steroid-free clinical remission (Harvey-Bradshaw Index ≤4) at 24 and 52 weeks. Secondary objectives were combined biological remission (fecal calprotectin levels &lt;250 mcg/g and C-reactive protein &lt;10 mg/dl), safety and persistence of ustekinumab during the follow-up period. Results A total of 89 patients with CD treated with ustekinumab (59,6% women; median disease duration 10 years) were included. The median follow-up was 60 weeks and 55 patients reached one year of follow-up. A 39,3% of the patients had history of previous abdominal surgery and 27% had been treated with 2 or more biologics. A 25,8% and 12,4% of the patients were on steroids and immunosupresants at the induction. The percentages of steroid-free clinical remission at 24 and 52 weeks were 42% and 54% respectively (Figure 1). Combined biological remission at 24 and 52 weeks was achieved in 33% and 45% of the patients respectively. Ustekinumab persistence was 88% at 12 months of follow-up (Figure 2). There were 14 suspensions mainly due to lack of response. Only 13 adverse events were documented in 9 patients (11.5%), none of them serious. Figure 1. Steroid-free clinical and biological remission percentages of ustekinumab at 16,24,52,76 and 104 weeks. Figure 2. Kaplan-Meier curve showing the durability of ustekinumab throughout the follow-up period. Conclusion Ustekinumab was effective and safe in a high proportion of patients with CD that were resistant to conventional immunosuppressant and antitumor necrosis factor drugs in this real-life practice cohort.

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