Vernia Filippo, Monaco Sabrina, Latella Giovanni
Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
J Clin Med. 2024 Jul 9;13(14):3993. doi: 10.3390/jcm13143993.
Ustekinumab is a monoclonal antibody approved for the treatment of IBD. This drug has a well-established efficacy; however, patients may not respond or lose response. The availability of other biological therapies prompts the need for comparative data between different agents to suggest first- or second-line strategies. Aim of this review is to compare the effectiveness of ustekinumab to other biologics in Crohn's disease and ulcerative colitis, as well as report the available data on dose escalation and reinduction. A systematic electronic search of the English literature was performed up to November 2023, using Medline (PubMed), Web of Science, Scopus and the Cochrane Library. Conference proceedings were also screened. Out of 659 citations, 80 relevant articles were selected and included in the present narrative review. Head-to-head comparisons of different biological drugs are relatively scarce, mostly deriving from indirect comparison or retrospective studies. Overall available data indicate similar effectiveness in the treatment of IBD patients. Dose escalation and reinduction strategies are well documented, but the optimal treatment schedule is still to be defined. Response and remission rates vary in different studies, and a proportion of patients fail to achieve clinical and endoscopic outcomes. However, both approaches are effective and safe in nonresponders and secondary loss of response. IBD patients may benefit from dose escalation or reinduction. Both strategies prove effective in regaining response in a proportion of patients, avoiding unnecessary early switch. Head-to-head trials are still needed to determine the exact placement of this drug compared to other biologics.
乌司奴单抗是一种被批准用于治疗炎症性肠病的单克隆抗体。这种药物疗效确切；然而，患者可能无反应或失去反应。其他生物疗法的出现促使需要不同药物之间的比较数据，以提出一线或二线治疗策略。本综述的目的是比较乌司奴单抗与其他生物制剂在克罗恩病和溃疡性结肠炎中的有效性，并报告剂量递增和再诱导的现有数据。截至2023年11月，使用Medline（PubMed）、科学网、Scopus和考克兰图书馆对英文文献进行了系统的电子检索。还筛选了会议论文集。在659篇文献中，选择了80篇相关文章并纳入本叙述性综述。不同生物药物的直接比较相对较少，大多来自间接比较或回顾性研究。总体现有数据表明，在治疗炎症性肠病患者方面有效性相似。剂量递增和再诱导策略有充分记录，但最佳治疗方案仍有待确定。不同研究中的缓解率和反应率各不相同，一部分患者未能实现临床和内镜下的治疗效果。然而，这两种方法在无反应者和继发反应丧失者中都是有效且安全的。炎症性肠病患者可能从剂量递增或再诱导中获益。两种策略在使一部分患者恢复反应方面均被证明有效，避免了不必要的过早换药。与其他生物制剂相比，仍需要直接比较试验来确定这种药物的确切定位。
