Servicio de Aparato Digestivo, Hospital Juan Ramón Jiménez, España.
Servicio de Aparato Digestivo, Hospital Juan Ramón Jiménez.
Rev Esp Enferm Dig. 2019 Sep;111(9):721. doi: 10.17235/reed.2019.5802/2018.
Secondary non-response to biological treatments tends to occur in a high number of patients who undergo treatment with antiTNF, and it has also been observed in patients treated with vedolizumab or ustekinumab. The initial rescue guideline recommends intensifying the treatment by reducing the interval or increasing maintenance dosage. In the case of ustekinumab, the patients who began this treatment prior to its approval for treatment of Crohn's disease, were given a subcutaneous induction with no defined guideline and a maintenance dosage of 90 mg every eight weeks. Following secondary non-response in these patients, it was proposed that rescue be undertaken via intravenous reinduction adjusted for weight. We present a case of a patient with Crohn's disease with failure to respond to infliximab, adalimumab and vedolizumab who began treatment with ustekinumab prior to official approval. There was non-response at eight months but remission was achieved after reinduction with ustekinumab, adjusted for weight. This rescue guideline could be a cost-effective way to reinduce remission in this group of patients.
生物治疗的继发无应答倾向于发生在大量接受抗 TNF 治疗的患者中，也观察到在接受 vedolizumab 或 ustekinumab 治疗的患者中出现这种情况。最初的抢救指南建议通过减少间隔或增加维持剂量来加强治疗。对于 ustekinumab，在其被批准用于治疗克罗恩病之前开始这种治疗的患者接受了皮下诱导，但没有明确的指南，每 8 周维持剂量为 90 毫克。在这些患者出现继发无应答后，建议通过根据体重调整的静脉重新诱导进行抢救。我们报告了一例克罗恩病患者，该患者对英夫利昔单抗、阿达木单抗和 vedolizumab 治疗无反应，在正式批准之前开始使用 ustekinumab 治疗。在 8 个月时无应答，但在用 ustekinumab 重新诱导后达到缓解，根据体重进行了调整。对于这组患者，这种抢救指南可能是重新诱导缓解的一种具有成本效益的方法。
