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Tursi A, Mocci G, Scaldaferri F, Napolitano D, Maresca R, Pugliese D, Semprucci G, Savarino E, Cuomo A, Donnarumma L, Bodini G, Pasta A, Maconi G, Cataletti G, Pranzo G, Rodinò S, Sebkova L, Costa F, Ferronato A, Gaiani F, Marzo M, Luppino I, Fabiano G, Paese P, Elisei W, Monterubbianesi R, Faggiani R, Grossi L, Serio M, Scarcelli A, Lorenzetti R, Allegretta L, Chiri S, Grasso G, Antonelli E, Bassotti G, Spagnuolo R, Luzza F, Fanigliulo L, Rocco G, Sacchi C, Zampaletta C, Rocchi C, Bolognini L, Bendia E, Bianco MA, Capone P, Meucci C, Colucci R, Tonti P, Neve V, Della Valle N, Felice C, Pica R, Cocco A, Forti G, Onidi FM, Usai Satta P, Checchin D, Gravina AG, Pellegrino R, Picchio M, Papa A. Ustekinumab safety and effectiveness in patients with ulcerative colitis: results from a large real-life study. Expert Opin Biol Ther 2024; 24:101-109. [PMID: 38250818 DOI: 10.1080/14712598.2024.2309300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/19/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Ustekinumab (UST) is an interleukin-12/interleukin-23 receptor antagonist recently approved for treating ulcerative colitis (UC) but with limited real-world data. Therefore, we evaluated the effectiveness and safety of UST in patients with UC in a real-world setting. RESEARCH DESIGN AND METHODS This is a multicenter, retrospective, observational cohort study. The primary endpoints were the clinical remission rate (partial Mayo score, PMS, ≤1) and the safety of UST. Other endpoints were corticosteroid-free remission (CSFR) rate, clinical response rate (PMS reduction of at least 2 points), and fecal calprotectin (FC) reduction at week 24. RESULTS We included 256 consecutive patients with UC (M/F 139/117, median age 52). The clinical remission and clinical response rates at eight weeks were 18.7% (44/235) and 53.2% (125/235), respectively, and 27.6% (42/152) and 61.8% (94/152) at 24 weeks, respectively. At 24 weeks, CSFR was 20.3% (31/152), and FC significantly dropped at week 12 (p = 0.0004) and 24 (p = 0.038). At eight weeks, patients naïve or with one previous biologic treatment showed higher remission (p = 0.002) and clinical >response rates (p = 0.018) than patients previously treated with ≥ 2. Adverse events occurred in six patients (2.3%), whereas four patients (1.6%) underwent colectomy. CONCLUSION This real-world study shows that UST effectively and safely treats patients with UC.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria, Italy
- Department of Medical and Surgical Sciences, Catholic University, Rome, Italy
| | - Giammarco Mocci
- Division of Gastroenterology, "Brotzu" Hospital, Cagliari, Italy
| | - Franco Scaldaferri
- Digestive Diseases Centre (CEMAD), Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" Foundation, IRCCS, Rome, Italy
- School of Medicine, Catholic University, Rome, Italy
| | - Daniele Napolitano
- Digestive Diseases Centre (CEMAD), Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" Foundation, IRCCS, Rome, Italy
| | - Rossella Maresca
- Digestive Diseases Centre (CEMAD), Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" Foundation, IRCCS, Rome, Italy
| | - Daniela Pugliese
- Digestive Diseases Centre (CEMAD), Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" Foundation, IRCCS, Rome, Italy
- School of Medicine, Catholic University, Rome, Italy
| | - Gianluca Semprucci
- Gastroenterology Unit, Azienda Ospedale-Università di Padova (AOUP), Padua, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Azienda Ospedale-Università di Padova (AOUP), Padua, Italy
| | - Antonio Cuomo
- Division of Gastroenterology, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Laura Donnarumma
- Division of Gastroenterology, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Giorgia Bodini
- Department of Internal Medicine and Medical Specialties, Division of Gastroenterology, IRCCS "San Martino" Hospital, University of Genoa, Genoa, Italy
| | - Andrea Pasta
- Department of Internal Medicine and Medical Specialties, Division of Gastroenterology, IRCCS "San Martino" Hospital, University of Genoa, Genoa, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Milan, Italy
| | - Giovanni Cataletti
- Gastroenterology Unit, Department Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Milan, Italy
| | - Giuseppe Pranzo
- Ambulatory for IBD Treatment, "Valle D'Itria" Hospital, Martina Franca (TA), Italy
| | - Stefano Rodinò
- Division of Gastroenterology, "Ciaccio-Pugliese" Hospital, Catanzaro, Italy
| | - Ladislava Sebkova
- Division of Gastroenterology, "Ciaccio-Pugliese" Hospital, Catanzaro, Italy
| | - Francesco Costa
- IBD Unit, Department of General Surgery and Gastroenterology, Pisa University Hospital, Pisa, Italy
| | - Antonio Ferronato
- Digestive Endoscopy Unit, Hospital of Santorso, ULSS7, Santorso (VI), Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Manuela Marzo
- Division of Gastroenterology, "Veris-Delli Ponti" Hospital, Scorrano (LE), Italy
| | - Ileana Luppino
- Division of Gastroenterology, "Annunziata" Hospital, Cosenza, Italy
| | - Giulia Fabiano
- Division of Gastroenterology, "Annunziata" Hospital, Cosenza, Italy
| | - Pietro Paese
- Division of Gastroenterology, "Annunziata" Hospital, Cosenza, Italy
| | - Walter Elisei
- Division of Gastroenterology, A.O. "S. Camillo-Folanini", Rome, Italy
| | | | - Roberto Faggiani
- Division of Gastroenterology, A.O. "S. Camillo-Folanini", Rome, Italy
| | - Laurino Grossi
- Gastroenterology Unit, "Spirito Santo" Hospital, "G d'Annunzio" University, Pescara, Italy
| | - Mariaelena Serio
- Division of Gastroenterology, "San Salvatore" Hospital, Pesaro, Italy
| | | | - Roberto Lorenzetti
- Division of Gastroenterology, "Nuovo Regina Margherita" Territorial Hospital, Roma, Italy
| | - Leonardo Allegretta
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina (LE), Italy
| | - Stefania Chiri
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina (LE), Italy
| | - Giuseppina Grasso
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina (LE), Italy
| | - Elisabetta Antonelli
- Gastroenterology and Hepatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gabrio Bassotti
- Gastroenterology and Hepatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rocco Spagnuolo
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Francesco Luzza
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Libera Fanigliulo
- Division of Gastroenterology, "S.S. Annunziata" Hospital, Taranto, Italy
| | - Giulia Rocco
- Division of Gastroenterology, "Belcolle" Hospital, Viterbo, Italy
| | - Carlotta Sacchi
- Division of Gastroenterology, "Belcolle" Hospital, Viterbo, Italy
| | | | - Chiara Rocchi
- Division of Gastroenterology and Digestive Endoscopy, "Mater Olbia" Hospital, Olbia (SS), Italy
| | - Laura Bolognini
- Division of Digestive Diseases, Digestive Endoscopy and Inflammatory Bowel Diseases, A.O. "Ospedali Riuniti", Ancona, Italy
| | - Emanuele Bendia
- Division of Digestive Diseases, Digestive Endoscopy and Inflammatory Bowel Diseases, A.O. "Ospedali Riuniti", Ancona, Italy
| | - Maria Antonia Bianco
- Division of Gastroenterology, "T. Maresca" Hospital, Torre del Greco (NA), Italy
| | - Pietro Capone
- Division of Gastroenterology, "T. Maresca" Hospital, Torre del Greco (NA), Italy
| | - Costantino Meucci
- Division of Gastroenterology, "T. Maresca" Hospital, Torre del Greco (NA), Italy
| | - Raffaele Colucci
- Digestive Endoscopy Unit, "San Matteo degli Infermi" Hospital, Spoleto (PG), Italy
| | - Paolo Tonti
- Division of Gastroenterology, "A. Perrino" Hospital, Brindisi, Italy
| | - Viviana Neve
- Division of Gastroenterology, "A. Perrino" Hospital, Brindisi, Italy
| | | | - Carla Felice
- Division of Internal Medicine, "Ca' Foncello" University Hospital, Treviso, Italy
| | - Roberta Pica
- Division of Gastroenterology, IBD Unit, "S. Pertini" Hospital, Rome, Italy
| | - Andrea Cocco
- Division of Gastroenterology, IBD Unit, "S. Pertini" Hospital, Rome, Italy
| | - Giacomo Forti
- Division of Digestive Endoscopy, "S. Maria Goretti" Hospital, Latina, Italy
| | | | | | - Davide Checchin
- Division of Gastroenterology, " S Giovanni e Paolo" Hospital, Mestre - Venezia, Italy
| | - Antonietta Gerarda Gravina
- Department of Precision Medicine, Hepatogastroenterology and Digestive Endoscopy Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Raffaele Pellegrino
- Department of Precision Medicine, Hepatogastroenterology and Digestive Endoscopy Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcello Picchio
- Division of General Surgery, "P. Colombo" Hospital, ASL Roma 6, Velletri (Roma), Italy
| | - Alfredo Papa
- Digestive Diseases Centre (CEMAD), Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" Foundation, IRCCS, Rome, Italy
- School of Medicine, Catholic University, Rome, Italy
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Barberio B, Marsilio I, Buda A, Bertin L, Semprucci G, Zanini A, Crepaldi M, Zingone F, Savarino E. Efficacy and safety of oral beclomethasone dipropionate and budesonide MMX versus 5-aminosalicylates or placebo in ulcerative colitis: a systematic review and meta-analysis. Therap Adv Gastroenterol 2023; 16:17562848231188549. [PMID: 37538919 PMCID: PMC10395162 DOI: 10.1177/17562848231188549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023] Open
Abstract
Background Low bioavailability steroids, including beclomethasone dipropionate (BDP) and budesonide MMX, have been developed to ensure colonic targeting and low systemic activity than systematic corticosteroids in treating patients with ulcerative colitis (UC). Objectives This systematic review and meta-analysis evaluated the efficacy and safety of BDP and budesonide MMX® compared with 5-aminosalicylic acid (5-ASAs) or placebo, in patients with mild-to-moderate UC. Design Systematic review and meta-analysis. Methods We searched MEDLINE, EMBASE, and the Cochrane central register of controlled trials from inception to December 2021. We included all available randomized controlled trials (RCTs) comparing oral BDP or budesonide MMX with 5-ASAs or with placebo in induction of remission of mild-to-moderate UC. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results We identified two RCTs comparing BDP 5 mg with 5-ASA, one RCTs comparing BDP 10 mg with 5-ASA, two RCTs BDP 5 mg versus placebo, one RCT BDP 10 mg versus placebo, two RCTs budesonide MMX 9 mg versus 5-ASA, and six RCTs budesonide MMX 9 mg versus placebo. In terms of achieving clinical remission or improvement, BDP 5 mg, BDP 10 mg, and budesonide MMX 9 mg were more effective than placebo (OR 2.36, 95% CI 1.37-4.08; OR 2.23, 95% CI 1.02-4.87; and OR 2.03, 95% CI 1.45-2.85, respectively). The drugs were also more effective than placebo in achieving endoscopic remission. Regarding the comparisons with 5-ASA, we found no differences between 5-ASA and BDP 5 mg or BDP 10 mg or budesonide MMX 9 mg in achieving clinical remission or improvement (OR 0.90, 95% CI 0.51-1.57; OR 1.54, 95% CI 0.42-5.64; and OR 1.17, 95% CI 0.82-1.66). However, 5-ASA was more effective than budesonide MMX 9 mg in achieving histological remission (OR 0.33, 95% CI 0.16-0.70). Overall, all the drugs were safe and well tolerated. Conclusion Low bioavailability steroids were more effective than placebo in achieving clinical remission, clinical and endoscopic remission, and histological remission. No differences were found between 5-ASA and BDP or budesonide MMX. Surely, more RCTs, also comparing BDP and budesonide MMX, are mandatory to confirm or not these results.
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Affiliation(s)
| | | | - Andrea Buda
- Gastroenterology Unit, Department of Gastrointestinal Oncological Surgery, Santa Maria del Prato Hospital, Feltre, Italy
| | - Luisa Bertin
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Gianluca Semprucci
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Annalisa Zanini
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Martina Crepaldi
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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