title: Patients with Refractory Crohn's Disease Successfully Treated with Ustekinumab.
abstract: BACKGROUND
  Ustekinumab is a new biologic therapy targeting interleukin-12 and interleukin -23. It is currently approved for the treatment of psoriasis, but clinical trials have shown that it can induce and maintain remission in Crohn's disease (CD). We aim to evaluate effectiveness of ustekinumab in the treatment of CD.
  
  
  METHODS
  A retrospective chart review was performed including patients (pts) from 2 academic medical centers with complicated, refractory CD started on ustekinumab between June 2011 and June 2014. Pts were treated based on a novel subcutaneous dosing schedule designed to simulate the intravenous load used in clinical trials.
  
  
  RESULTS
  Forty-five pts were treated with ustekinumab during this study period. Of the pts who had clinical parameters available before and after medication start, 46% achieved clinical response (Harvey-Bradshaw index decrease ≥ 3) and 35% achieved clinical remission (Harvey-Bradshaw index ≤ 3). Short inflammatory bowel disease questionnaire scores increased significantly (46 [20, 68] to 55 [32, 70], P < 0.05). Erythrocyte sedimentation rate decreased significantly (20 [3, 54] to 12 [0, 42] mm/h, P < 0.05). C-reactive protein decreased significantly (4.9 [0.3, 111] to 3.3 [0.2, 226] mg/L, P < 0.05). Seventy-six percent of patients demonstrated an endoscopic response and 24% achieved complete endoscopic remission. Twelve patients (26%) were hospitalized for IBD-related issues. Four pts had infection-related complications. Six pts (13%) underwent surgery for IBD-related issues. Three pts stopped ustekinumab, 1 for pt preference and 2 for the lack of response.
  
  
  CONCLUSIONS
  Using a novel subcutaneous dosing schedule, ustekinumab was successful in improving clinical, laboratory, and endoscopic markers of disease activity in patients with severe, refractory CD.
authors.affiliation: *Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee; †Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; and ‡Department of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Harris
authors.forename: Sara
authors.initials: S
authors.lastname: Horst
authors.forename: Akash
authors.initials: A
authors.lastname: Gadani
authors.forename: Anne
authors.initials: A
authors.lastname: Nohl
authors.forename: Kim
authors.initials: K
authors.lastname: Annis
authors.forename: Caroline
authors.initials: C
authors.lastname: Duley
authors.forename: Dawn
authors.initials: D
authors.lastname: Beaulieu
authors.forename: Leyla
authors.initials: L
authors.lastname: Ghazi
authors.forename: David A
authors.initials: DA
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004351:Drug Resistance / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D000069549:Ustekinumab / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D000069549:Ustekinumab