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Axiaris G, Ioannou A, Papoutsaki M, Marinos L, Liontos M, Michopoulos S, Zampeli E. Case Report: Malignant melanoma in a patient with Crohn's disease treated with ustekinumab. F1000Res 2023; 11:424. [PMID: 37867623 PMCID: PMC10589619 DOI: 10.12688/f1000research.110356.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/24/2023] Open
Abstract
The cornerstone of inflammatory bowel disease (IBD) treatment is immunomodulators. IBD patients are at increased risk of intestinal and extraintestinal malignancy. Ustekinumab is a fully humanized monoclonal anti-IL12/23 antibody with a good safety profile. Malignancies of breast, colon, head and neck, kidney, prostate, thyroid, and non-melanoma skin cancer have been reported among patients who received ustekinumab. We report the case of a 42-year-old Crohn's patient on long-term treatment with ustekinumab, who developed achromatic malignant melanoma. Crohn's was diagnosed at the age of 15, with upper and lower gastrointestinal involvement and was initially treated with azathioprine (2mg/kg for 4 years) and infliximab (5mg/kg for 6 weeks). Due to ileal obstruction, the patient underwent stricturoplasty and received adalimumab (40mg every other week) for two years. He then discontinued therapy and a year later underwent right hemicolectomy. Adalimumab was reinstituted (40mg every other week) and the patient remained in clinical remission for two years. His overall exposure to adalimumab was four years. Ustekinumab was initiated due to a relapse and after 3 years, an incident of scalp itching led to the diagnosis metastatic achromatic malignant melanoma bearing BRAF V600E mutation. He received targeted therapy with an initial good response. We aim to point out the risk of dermatologic malignancy in IBD patients on long-term immunosuppression and the lifelong and meticulous evaluation that is required.
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Affiliation(s)
- Georgios Axiaris
- Gastroenterology Department, Alexandra General Hospital, Athens, Greece, 11528, Greece
| | - Alexandros Ioannou
- Gastroenterology Department, Alexandra General Hospital, Athens, Greece, 11528, Greece
| | - Marina Papoutsaki
- Dermatology Department, Syggros Hospital, Athens, Greece, 11528, Greece
| | - Leonidas Marinos
- Pathology Department, Evangelismos Hospital, Atherns, Greece, 11528, Greece
| | - Michael Liontos
- Oncology Department, Alexandra General Hospital, Athens, Greece, 11528, Greece
| | - Spyridon Michopoulos
- Gastroenterology Department, Alexandra General Hospital, Athens, Greece, 11528, Greece
| | - Evanthia Zampeli
- Gastroenterology Department, Alexandra General Hospital, Athens, Greece, 11528, Greece
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Zheng YJ, Ho W, Sanlorenzo M, Vujic I, Daud A, Algazi A, Rappersberger K, Ortiz-Urda S. Melanoma risk during immunomodulating treatment. Melanoma Res 2022; 32:411-418. [PMID: 35993892 DOI: 10.1097/cmr.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Immunosuppressive therapy is standard for the treatment of inflammatory diseases and for minimizing rejection in transplant patients. However, immunosuppressant drugs are associated with an increased risk of certain cancers. In particular, melanoma is an immunogenic tumor and as such, is strongly influenced by the immune system. We performed this literature review to summarize the effects of commonly used immunomodulating agents on melanoma development, recurrence and progression. We outline the mechanism of action of each drug and discuss the available evidence on its influence on melanoma. Based on existing literature, we recommend avoiding the following agents in patients with a history of invasive melanoma: cyclosporine, sirolimus, natalizumab, IL-6 inhibitors, cyclophosphamide, methotrexate and the tumor necrosis factor-alpha inhibitors infliximab and etanercept. If there are no viable alternative agents, we recommend for these patients to see a dermatologist every 6 months for a thorough skin examination.
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Affiliation(s)
- Yixuan James Zheng
- Department of Dermatology, University of California San Francisco
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Wilson Ho
- Department of Dermatology, University of California San Francisco
| | - Martina Sanlorenzo
- Department of Dermatology, University of California San Francisco
- Department of Oncology, University of Turin, Torino, Italy
- Department of Medicine, Institute of Cancer Research, Medical University of Vienna
| | - Igor Vujic
- Department of Dermatology, University of California San Francisco
- Department of Dermatology and Venereology, The Rudolfstiftung Hospital
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Adil Daud
- Department of Dermatology, University of California San Francisco
| | - Alain Algazi
- Department of Dermatology, University of California San Francisco
| | - Klemens Rappersberger
- Department of Dermatology and Venereology, The Rudolfstiftung Hospital
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Lenti MV, Dolby V, Clark T, Hall V, Tattersall S, Fairhurst F, Kenneth C, Walker R, Kemp K, Borg‐Bartolo S, Limdi JK, Taylor J, Townsend T, Subramanian S, Storey D, Assadsangabi A, Stansfield C, Smith P, Byrne D, De Silvestri A, Selinger C. A propensity score-matched, real-world comparison of ustekinumab vs vedolizumab as a second-line treatment for Crohn's disease. The Cross Pennine study II. Aliment Pharmacol Ther 2022; 55:856-866. [PMID: 34935160 PMCID: PMC9305775 DOI: 10.1111/apt.16742] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/06/2021] [Accepted: 12/09/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal choice of biological agents after failure of anti-tumour-necrosis-factor-(TNF)α agent in Crohn's disease (CD) is yet to be defined. AIMS To assess the effectiveness and safety of ustekinumab compared to vedolizumab as second-line treatment in CD patients who failed anti-TNFα therapy. METHODS Retrospective analysis of clinical response and remission at 14 and 52 weeks to ustekinumab by physician global assessment (PGA). A propensity score-matched analysis with a cohort treated with vedolizumab was performed. RESULTS Of 282 patients (mean age 40 ± 15, F:M ratio 1.7:1) treated with ustekinumab, clinical response or remission was reached by 200/282 patients (70.9%) at 14 weeks, and 162/259 patients (62.5%) at 52 weeks. Overall, 74 adverse events occurred, of which 26 were labelled as serious (8.3 per 100 person-year). After exclusion of patients without prior anti-TNFα exposure and patients previously exposed to vedolizumab or ustekinumab, we analysed 275/282 patients (97.5%) on ustekinumab and 118/135 patients (87.4%) on vedolizumab. Propensity score analysis revealed that at 14 weeks, patients treated with ustekinumab were 38% (95% CI 25%-50%; P < 0.001) more likely to achieve clinical remission, while at 52 weeks, the difference of 9% (95% CI -15% to 33%; P = 0.462) was not significant. CONCLUSIONS Ustekinumab was effective and well tolerated in this real-world cohort. While ustekinumab proved more effective at 14-weeks, we found no statistically significant differences at 52 weeks compared to vedolizumab.
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Ustekinumab-induced chronic lymphocytic leukemia in a patient with psoriatic arthritis. Reumatologia 2021; 59:58-61. [PMID: 33707797 PMCID: PMC7944959 DOI: 10.5114/reum.2021.102618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by skin and joint involvement. The disease may present with various joint pattern involvement, which sometimes may lead to joint destruction and deformity. Early diagnosis and treatment with disease-modifying anti-rheumatic drugs may prevent joint deformity. Recently there are many new treatment options including biologic drugs. Ustekinumab, an interleukin 12/23 inhibitor, has proven efficacy in the treatment of psoriatic arthritis. Like other biologic drugs (anti-TNF-α), there are contradictory data about the safety of ustekinumab and possible relationship with cancer development. Herein we report the development of chronic lymphocytic leukemia in a patient with PsA treated with ustekinumab.
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Wu J, Smogorzewski J. Ustekinumab for the treatment of paradoxical skin reactions and cutaneous manifestations of inflammatory bowel diseases. Dermatol Ther 2021; 34:e14883. [PMID: 33594811 DOI: 10.1111/dth.14883] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/19/2021] [Accepted: 02/06/2021] [Indexed: 12/25/2022]
Abstract
Ustekinumab (STELARA), a human monoclonal antibody directed against IL-12 and IL-23, is FDA-approved to treat psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. Increasing recognition of paradoxical skin reactions induced by older biologic therapies used for inflammatory bowel diseases (IBD), such as, adalimumab and infliximab, has led to the investigation of ustekinumab for the treatment of the cutaneous and gastrointestinal manifestations of IBD. In addition, ustekinumab may show efficacy in treating paradoxical cutaneous reactions to tumor necrosis factor-alpha (TNF-α) inhibitors. A search of the Medline/PubMed database, with additional citations obtained from the references section of relevant articles, yielded 22 articles that were included in this review. Ustekinumab is a safe and effective option for treating the cutaneous manifestations of IBD, such as, metastatic Crohn's disease and pyoderma gangrenosum. It is also an effective treatment for TNF-α inhibitor-induced paradoxical skin reactions, such as, psoriasis that do not remit spontaneously or with conventional treatment. Additional studies should focus on the optimal dosing of ustekinumab for dermatologic conditions beyond psoriasis.
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Affiliation(s)
- Jessica Wu
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jan Smogorzewski
- Division of Dermatology, Harbor-UCLA Medical Center, Torrance, California, USA
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Berge LAM, Andreassen BK, Stenehjem JS, Heir T, Karlstad Ø, Juzeniene A, Ghiasvand R, Larsen IK, Green AC, Veierød MB, Robsahm TE. Use of Immunomodulating Drugs and Risk of Cutaneous Melanoma: A Nationwide Nested Case-Control Study. Clin Epidemiol 2020; 12:1389-1401. [PMID: 33376408 PMCID: PMC7755337 DOI: 10.2147/clep.s269446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/08/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose Cutaneous melanoma is among the fastest growing malignancies in Norway and ultraviolet radiation (UVR) exposure is the primary environmental risk factor. Immunomodulating drugs can increase skin photosensitivity and suppress immune responses, and by such mechanisms influence melanoma risk. We, therefore, aimed to examine the associations between use of immunomodulating drugs and melanoma risk, at a nationwide population level. Patients and Methods In the Cancer Registry of Norway, we identified all cases aged 18-85 with a first primary cutaneous melanoma diagnosed in 2007-2015 (n=12,106). These were matched to population controls from the Norwegian National Registry 1:10 (n=118,564), on sex and year of birth using risk set sampling. Information on prescribed drugs (2004-2015) was obtained by linkage to the Norwegian Prescription Database (NorPD). Conditional logistic regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for associations between use of immunomodulating drugs (immunosuppressants and corticosteroids) and melanoma risk, adjusted for ambient UVR and other drug use. Results Compared with ≤1 prescription, use of ≥8 prescriptions of immunosuppressants was associated with increased risk of melanoma (RR 1.50, 95% CI 1.27, 1.77). Similar associations were found for subgroups of immunosuppressants: drugs typically prescribed to organ transplant recipients (OTRs) (RR 2.02, 95% CI 1.35, 3.03) and methotrexate (RR 1.27, 95% CI 1.04, 1.55). Similar results were found for high levels of cumulative doses and across all histological subtypes. Use of corticosteroids was not associated with melanoma risk. Conclusion We found a positive association between use of immunosuppressants and melanoma risk, with the highest risk seen for drugs prescribed to OTRs. Knowledge about this risk increase is important for physicians and users of these drugs, for intensified surveillance, awareness and cautious sun exposure.
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Affiliation(s)
- Leon Alexander Mclaren Berge
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | | | - Jo Steinson Stenehjem
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Trond Heir
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Ischemia Study, Oslo University Hospital, Oslo, Norway
| | - Øystein Karlstad
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Asta Juzeniene
- Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Reza Ghiasvand
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | | | - Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Molecular Oncology Unit, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Marit Bragelien Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Trude Eid Robsahm
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
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Charakopoulos E, Spyrou I, Viniou NA, Giannakopoulou N, Hatzidavid S, Diamantopoulos PT. A case report of Hodgkin lymphoma in a patient treated with ustekinumab for psoriasis. Medicine (Baltimore) 2020; 99:e20048. [PMID: 32481271 PMCID: PMC7249998 DOI: 10.1097/md.0000000000020048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/08/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ustekinumab is a biological agent that inhibits interleukin 12 and 23 and has been approved for the treatment of moderate and severe plaque psoriasis. There have been case reports that raise concerns about its oncogenic potential. We are the first authors to report a case of Hodgkin lymphoma in a psoriatic patient receiving ustekinumab. PATIENT CONCERNS A 22-year-old asymptomatic female patient presented to our department to investigate an enlarged cervical lymph node. Her past history was unremarkable, except for psoriasis since age 13. Two months before presentation the decision to administer Ustekinumab was taken and the patient had already received 3 doses. DIAGNOSES During workup a Stage IV Hodgkin lymphoma was discovered. INTERVENTIONS Ustekinumab administration was discontinued. The patient received treatment with the ABVD regimen. OUTCOMES The patient's disease was refractory to the above-mentioned treatment. Therefore, a more aggressive regimen (BEACOPP escalated) was administered. LESSONS Growing postmarketing surveillance data and case reports indicate that further research is warranted in order to elucidate a potential association between Ustekinumab and malignancy.
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Niehues T, Özgür TT. The Efficacy and Evidence-Based Use of Biologics in Children and Adolescents: Using Monoclonal Antibodies and Fusion Proteins as Treatments. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:703-710. [PMID: 31711560 PMCID: PMC6891884 DOI: 10.3238/arztebl.2019.0703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/27/2018] [Accepted: 07/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Monoclonal antibodies (mAb) and fusion proteins (FP) are increasingly being used in children and adolescents. In this review, we analyze the evidence for their safety and efficacy in the treatment of the most common chronic inflammatory diseases. METHODS We systematically searched PubMed, AWMF.org, and other databases for high-quality trials (i.e., randomized controlled trials with clinical primary endpoints) and guidelines published at any time up to 10 December 2018 that dealt with mAb and FP that are approved for pediatric use. The search term was "monoclonal anti- body/fusion protein [e. g. adalimumab] AND children." RESULTS The 620 hits included 25 high-quality trials (20 of them manufacturer- sponsored) on 9 mAb/FP (omalizumab, adalimumab, etanercept, ustekinumab, infliximab, golimumab, anakinra, canakinumab, tocilizumab, and abatacept), as well as 6 guidelines (3 each of levels S3 and S2k) on the treatment of bronchial asthma, psoriasis, juvenile idopathic arthritis, and chronic inflammatory bowel diseases. For none of these conditions are mAb and FP the drugs of first choice. Adverse drug effects are rare but sometimes severe (infection, immune dysregulation, tumors). CONCLUSION The retrieved trials have deficiencies that make it difficult to reliably evaluate the efficacy, safety, and utility of mAb/FP for children and adolescents with chronic inflammatory diseases. mAb/FP nonetheless represent a treatment option to be considered in case conventional immune-modulating drugs are ineffective. Researcher-initiated, high-quality trials and manufacturer-independent, systematic long-term evaluations of adverse effects (e.g., tumors) are sorely needed.
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Affiliation(s)
- Tim Niehues
- Department of Pediatrics and Adolescent Medicine, HELIOS Klinikum Krefeld
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Simon EG, Samuel S, Ghosh S, Moran GW. Ustekinumab: a novel therapeutic option in Crohn's disease. Expert Opin Biol Ther 2017; 16:1065-74. [PMID: 27341173 DOI: 10.1080/14712598.2016.1205582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Although anti-tumour necrosis factor (TNF) agents have caused a paradigm shift in the management of moderate-to-severe Crohn's, they are sometimes associated with diminished or absent response in a considerable proportion of patients. Hence agents targeting pathways other than TNF are needed. Ustekinumab is a monoclonal antibody directed against the p40 subunit of IL-12 and 23. AREAS COVERED This manuscript summarises the available evidence on the efficacy and safety of Ustekinumab in Crohn's disease through data available from randomised controlled trials and compassionate use programs across the world. EXPERT OPINION Current literature strongly supports the fact that ustekinumab is clinically efficacious and reasonably safe for induction and maintenance of remission in moderate-to-severe Crohn's disease.
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Affiliation(s)
- E G Simon
- a Department of Gastroenterology , Christian Medical College , Vellore , India.,b NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - S Samuel
- b NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - S Ghosh
- c Department of Medicine and IBD Clinic , University of Calgary , Calgary , Canada
| | - G W Moran
- b NIHR Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
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Verstockt B, Van Assche G, Vermeire S, Ferrante M. Biological therapy targeting the IL-23/IL-17 axis in inflammatory bowel disease. Expert Opin Biol Ther 2016; 17:31-47. [PMID: 27817215 DOI: 10.1080/14712598.2017.1258399] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION As many inflammatory bowel disease (IBD) patients do not benefit from long-term anti-tumour necrosis factor treatment, new anti-inflammatories are urgently needed. After the discovery of the interleukin (IL) 23/17 axis being pivotal in IBD pathogenesis, many different compounds were developed, targeting different components within this pathway. Areas covered: A literature search to March 2016 was performed to identify the most relevant reports on the role of the IL-23/IL-17 axis in IBD and on the different molecules targeting this pathway. First, the authors briefly summarize the immunology of the IL-23/IL-17 pathway to elucidate the mode of action of all different agents. Second, they describe all different molecules targeting this pathway. Besides discussing efficacy and safety data, they also explore immunogenicity, exposure during pregnancy and pharmacokinetics. Expert opinion: A new era in IBD treatment has recently been initiated: besides immunomodulators and TNF-antagonists, anti-adhesion molecules and monoclonal antibodies targeting the IL-23/IL-17 pathway have been developed. Biomarkers for personalized medicine are urgently needed. This therapeutic (r)evolution will further improve disease-related and patient-reported outcome, though a lot of questions should still be addressed in future years.
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Affiliation(s)
- Bram Verstockt
- a Translational Research in Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine , KU Leuven , Leuven , Belgium.,b Department of Medicine and Cambridge Institute for Medical Research , University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus , Cambridge , UK
| | - Gert Van Assche
- a Translational Research in Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine , KU Leuven , Leuven , Belgium.,c Department of Gastroenterology and Hepatology , University Hospitals Leuven, KU Leuven , Leuven , Belgium
| | - Séverine Vermeire
- a Translational Research in Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine , KU Leuven , Leuven , Belgium.,c Department of Gastroenterology and Hepatology , University Hospitals Leuven, KU Leuven , Leuven , Belgium
| | - Marc Ferrante
- a Translational Research in Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine , KU Leuven , Leuven , Belgium.,c Department of Gastroenterology and Hepatology , University Hospitals Leuven, KU Leuven , Leuven , Belgium
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Simon EG, Ghosh S, Iacucci M, Moran GW. Ustekinumab for the treatment of Crohn's disease: can it find its niche? Therap Adv Gastroenterol 2016; 9:26-36. [PMID: 26770265 PMCID: PMC4699281 DOI: 10.1177/1756283x15618130] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Crohn's disease is an immune-mediated disease that results in panenteric chronic inflammation in genetically predisposed individuals exposed to an appropriate environment. The past two decades have witnessed the emergence of an important class of drugs known as anti-tumour necrosis factor (TNF) agents in the treatment of Crohn's disease. Unfortunately, the utility of these agents have been hampered by primary and secondary nonresponse in a significant proportion of patients. Ustekinumab, a monoclonal antibody to the p40 subunit of interleukin (IL) 12 and 23, is a novel pharmacotherapy for this patient cohort that offers an out-of-class option. It is approved for use in psoriasis and psoriatic arthritis, and has now been evaluated in phase II trials for moderate-to-severe Crohn's disease. We here review the published literature and describe a potential clinical role for its use in this disease cohort.
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Affiliation(s)
- Ebby G. Simon
- Department of Gastroenterology, Christian Medical College, Vellore, India NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK
| | - Subrata Ghosh
- Department of Medicine and IBD Clinic, University of Calgary, Calgary, Alberta, Canada
| | - Marietta Iacucci
- Department of Medicine and IBD Clinic, University of Calgary, Calgary, Alberta, Canada
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Abstract
Crohn's disease (CD) results from a pathological immune response to luminal antigens in genetically predisposed individuals. Since the causes of CD are complex and only partially understood, treatment is based on the empiric use of anti-inflammatory drugs. Although multiple therapies for CD currently exist, a substantial proportion of patients are unresponsive to conventional agents. Approximately a third of patients fail treatment with TNF antagonists, and up to 40% of patients who initially benefit subsequently lose response. Accordingly, new approaches are required. Ustekinumab, a fully human IgG1-κ monoclonal antibody to the p40 subunit shared by IL-12 and IL-23, has emerged as a promising new treatment for both psoriasis and CD. This article reviews the available data regarding the mechanism of action, pharmacokinetics, efficacy and safety of ustekinumab in CD.
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Affiliation(s)
- Reena Khanna
- Department of Medicine, Robarts Research Institute, University of Western Ontario, PO Box 5015, 100 Perth Drive, London, ON N6A 5K8, Canada
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13
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Guerra I, Gisbert JP. Onset of psoriasis in patients with inflammatory bowel disease treated with anti-TNF agents. Expert Rev Gastroenterol Hepatol 2013; 7:41-8. [PMID: 23265148 DOI: 10.1586/egh.12.64] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anti-TNF agents are widely used in the treatment of some inflammatory diseases, such as inflammatory bowel disease and psoriasis. Their use has led to a significant advance in the treatment of these diseases. Paradoxically, the onset of psoriatic lesions has been observed in patients on anti-TNF treatment. The cause of this side effect has not yet been clearly identified. In recent years, an increasing number of cases of psoriasis related to anti-TNF therapy in inflammatory bowel disease patients have been reported. Although withdrawal of anti-TNF was usually implemented in the first reports, in more recent series the maintenance of the drug with topical therapy, with the exception of the most severe or extensive forms of skin lesions, appears to be the treatment of choice. This article summarizes the relevant literature, discusses the etiopathology, epidemiology, location and phenotypes of psoriatic lesions and the management of this side effect.
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Affiliation(s)
- Iván Guerra
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Camino del Molino 2, Madrid 28942, Spain.
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