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Fumery M, Defrance A, Roblin X, Altwegg R, Caron B, Hébuterne X, Stefanescu C, Meyer A, Nachury M, Laharie D, Nancey S, Le Berre C, Serrero M, Geyl S, Giletta C, Ah-Soune P, Duveau N, Uzzan M, Abitbol V, Biron A, Tran-Minh ML, Paupard T, Vuitton L, Elgharabawy Y, Peyrin-Biroulet L. Effectiveness and safety of risankizumab induction therapy for 100 patients with Crohn's disease: A GETAID multicentre cohort study. Aliment Pharmacol Ther 2023; 57:426-434. [PMID: 36534763 DOI: 10.1111/apt.17358] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/18/2022] [Accepted: 12/04/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Phase III trials have demonstrated the efficacy of risankizumab in moderate-to-severe Crohn's disease (CD), but no real-world data are currently available. We aimed to assess the short-term effectiveness and safety of risankizumab in patients with CD. METHODS From May 2021 to May 2022, all patients with refractory luminal CD treated with risankizumab in 22 French GETAID centres were retrospectively included. The primary endpoint was steroid-free clinical remission at week 12 (Harvey-Bradshaw [HB] score <5). Secondary endpoints included clinical response (≥3-point decrease of HB score and/or (HB) score <5), biochemical remission (CRP ≤ 5 mg/L), need for CD-related surgery and adverse events. RESULTS Among the 100 patients included, all have been previously exposed to anti-TNF agents, 94 to vedolizumab, 98 to ustekinumab (all exposed to at least three biologics) and 61 had a previous intestinal resection. All but three (97%) received a 600 mg risankizumab intravenous induction at weeks 0-4-8. At week 12, steroid-free clinical remission was observed in 45.8% of patients, clinical remission in 58% and clinical response in 78.5%. In subgroup analysis restricted to patients with objective signs of inflammation at baseline (n = 79), steroid-free clinical remission at week 12 was observed in 39.2% of patients. Biochemical remission was observed in 50% of patients. Six patients discontinued risankizumab before the week 12 visit due to lack of efficacy. CD-related hospitalisation was needed in six patients, and three underwent intestinal resection. In multivariable analysis, only a history of ustekinumab loss of response (vs primary failure) (odds ratio (OR), 2.80; 95% CI: 1.07-7.82; p = 0.041) was significantly associated with clinical remission at week 12. Twenty adverse events (AE) occurred in 20 patients including 7 serious AE corresponding to 6 CD exacerbation and one severe hypertension. CONCLUSION In a cohort of highly refractory patients with luminal CD and multiple prior drug failures including ustekinumab, risankizumab induction provided a clinical response in about 3 out of 4 patients and steroid-free clinical remission in about half of patients.
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Affiliation(s)
- Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, and PeriTox, Université de Picardie, Amiens, France
| | - Antoine Defrance
- Groupe d'étude des Affections Inflammatoires du tube Digestif, GETAID, Paris, France
| | - Xavier Roblin
- Department of Gastroenterology, CHU of Saint-Etienne, Saint-Etienne, France
| | - Romain Altwegg
- Department of Gastroenterology, CHU of Montpellier, Montpellier, France
| | - Benedicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Xavier Hébuterne
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice and University Côte d'Azur, Nice, France
| | | | - Antoine Meyer
- Department of Gastroenterology, CHU Kremlin-Bicetre, APHP, Kremlin-Bicetre, France
| | - Maria Nachury
- Department of Gastroenterology, CHU of Lille, Lille, France
| | - David Laharie
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, CHU de Bordeaux, Hôpital Haut-Lévêque, Université de Bordeaux, Bordeaux, France
| | | | - Catherine Le Berre
- Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Inserm CIC 1413, Inserm UMR 1235, Institut des Maladies de l'Appareil Digestif (IMAD), Nantes Université, CHU Nantes, Nantes, France
| | - Melanie Serrero
- Department of Gastroenterology, CHU of Marseille, Marseille, France
| | - Sophie Geyl
- Department of Gastroenterology, CHU of Limoges, Limoges, France
| | - Cyrielle Giletta
- Department of Gastroenterology and Pancreatology, CHU of Toulouse RANGUEIL, Toulouse, France
| | | | - Nicolas Duveau
- Department of Gastroenterology, CH of Roubaix, Roubaix, France
| | - Mathieu Uzzan
- Gastroenterology Department, Henri Mondor Hospital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Paris Est Créteil University UPEC, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Vered Abitbol
- Department of Gastroenterology, Hopital Cochin, Paris, France
| | - Amelie Biron
- Department of Gastroenterology, CHU of Reims, Reims, France
| | | | - Thierry Paupard
- Department of Gastroenterology, Centre Hospitalier de Dunkerque, Dunkirk, France
| | - Lucine Vuitton
- Department of Gastroenterology, UMR 1098, University of Franche-Comté, Besançon, France
| | - Yasmine Elgharabawy
- Groupe d'étude des Affections Inflammatoires du tube Digestif, GETAID, Paris, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
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Laharie D, D'Haens G, Nachury M, Lambrecht G, Bossuyt P, Bouhnik Y, Louis E, Janneke van der Woude C, Buisson A, Van Hootegem P, Allez M, Filippi J, Brixi H, Gilletta C, Picon L, Baert F, Vermeire S, Duveau N, Peyrin-Biroulet L. Steroid-Free Deep Remission at One Year Does Not Prevent Crohn's Disease Progression: Long-Term Data From the TAILORIX Trial. Clin Gastroenterol Hepatol 2022; 20:2074-2082. [PMID: 34843987 DOI: 10.1016/j.cgh.2021.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Crohn's disease (CD) patients included in the Tailored Treatment With Infliximab for Active Crohn's Disease (TAILORIX) trial started infliximab in combination with an immunosuppressant for 1 year. The aim of the present study was to determine the long-term disease course beyond the study period. METHODS We compared the outcomes of patients who did or did not reach the primary end point of the TAILORIX trial, defined as sustained corticosteroid-free clinical remission from weeks 22 through 54, with no ulcers on ileocolonoscopy at week 54. The primary outcome of this follow-up study was the progression-free survival of CD defined by anal or major abdominal surgery, CD-related hospitalization, or the need for a new systemic CD treatment. RESULTS The 95 patients (median disease duration, 4.5 mo; interquartile range, 1.0-56.6 mo) analyzed, including 45 (47%) who achieved the primary end point, were followed up for a median duration of 64.2 months (interquartile range, 57.6-69.9 mo) after the end of the study period. There was no significant difference in CD progression-free survival at 1, 3, and 5 years between patients who achieved the TAILORIX primary end point and patients who did not (P = .64). No difference was observed between both groups for each component of CD progression: anal surgery, major abdominal surgery, CD-related hospitalization, or the need for a new systemic CD treatment. CONCLUSIONS Achieving a sustained clinical remission off steroids with complete endoscopic remission in this cohort of 95 patients with early CD was not associated with less disease progression. Prospective trials to define the therapeutic goals that change the natural history of CD and prevent complications are needed.
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Affiliation(s)
- David Laharie
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et Oncologie Digestive, Université de Bordeaux, Bordeaux, France.
| | - Geert D'Haens
- Hepato-Gastroenterology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Maria Nachury
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France
| | - Guy Lambrecht
- Gastroenterology Unit, Damiaan Hospital, Oostende, Belgium
| | - Peter Bossuyt
- Imelda Gastronintestinal Clinical Research Center, Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium
| | - Yoram Bouhnik
- Hepato-Gastroenterology Department, Beaujon Hospital
| | - Edouard Louis
- Gastroenterology Department, University Hospital, CHU Liège, Liège, Belgium
| | | | - Anthony Buisson
- Hepato-Gastroenterology Department, Hospital Estaing, Clermont-Ferrand, France
| | | | - Matthieu Allez
- Hepato-Gastroenterology Department, Saint-Louis Hospital, University of Paris VII, Paris, France
| | - Jérôme Filippi
- Department of Gastroenterology, Hôpital L'Archet, Nice, France
| | - Hedia Brixi
- CHU Robert Debré, Service d'Hépato-gastroentérologie et Oncologie Digestive, Reims, France
| | - Cyrielle Gilletta
- Department of Gastroenterology and Pancreatology, CHU de Toulouse, Toulouse, France
| | - Laurence Picon
- Department of Gastroenterology, Centre Hospitalier Regional Universitaire de Tours, Tours, France
| | | | - Séverine Vermeire
- University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nicolas Duveau
- Hepato-Gastroenterology Department, Roubaix Hospital, Roubaix, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm U1256, Nancy University Hospital, Lorraine University, Vandoeuvre-les-Nancy, France
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Duveau N, Nachury M, Gerard R, Branche J, Maunoury V, Boualit M, Wils P, Desreumaux P, Pariente B. Adalimumab dose escalation is effective and well tolerated in Crohn's disease patients with secondary loss of response to adalimumab. Dig Liver Dis 2017; 49:163-169. [PMID: 27899263 DOI: 10.1016/j.dld.2016.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/09/2016] [Accepted: 11/02/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although adalimumab is effective in Crohn's disease, most patients experience a loss of response over time. The aim of the present study was to evaluate efficacy and safety of adalimumab dose escalation and identify predictors of a clinical response in Crohn's disease patients with a secondary loss of response. METHODS We performed a retrospective and observational study including all Crohn's disease patients who underwent dose escalation of adalimumab after a secondary loss of response from 2007 to 2015. RESULTS A clinical response was observed in 99/124 (79%) patients at 3 months and in 62/107 (61%) patients at 12 months. The predictive factors of response to ADA dose escalation at 12 months on multivariate analysis were: maintenance therapy of 40mg every week rather than 80mg every other week (OR 3.64, 95% CI: 1.28-10.37) and a CRP level≤5mg/L at adalimumab dose escalation (OR 6.64, 95% CI: 1.40-27.53). Adalimumab was withdrawn in 4 patients due to side effects. CONCLUSIONS Adalimumab dose escalation is an effective and well-tolerated therapeutic option in patients with secondary loss of response. A 40mg every week optimized regimen was predictive of a response to ADA dose escalation.
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Affiliation(s)
- Nicolas Duveau
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Maria Nachury
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Romain Gerard
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Julien Branche
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Vincent Maunoury
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Medina Boualit
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Pauline Wils
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Pierre Desreumaux
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Benjamin Pariente
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille 2, Lille, France.
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