有效治疗急性重度溃疡性结肠炎(ASUC)患者是一项重大挑战,在有效的环孢菌素诱导治疗后,仍然缺乏可用的维持治疗选择。
■我们研究了环孢菌素和ustekinumab联合治疗对类固醇难治性ASUC患者的长期有效性和安全性。
■单中心,前瞻性研究。
■我们纳入了患有类固醇难治性ASUC的患者,其先前的晚期治疗多次失败,他们接受了环孢菌素和ustekinumab联合治疗。
■在纳入的11名患者中,10人先前对英夫利昔单抗失败,8人先前至少三次生物疗法失败。Mayo和Lichtiger的平均基线评分分别为10.9(9-12)和13.3(11-14),分别。在环孢菌素治疗开始后3.2周(1-8)开始乌司他单抗,并且联合治疗持续平均11.5周(4-20)。在第16周,有6例患者获得了临床反应,在第48周,有5例患者获得了无类固醇临床缓解。在第16周,五名患者实现了内窥镜缓解,在第52周,五名患者实现了组织学缓解。肠超声显示乙状结肠的平均肠壁增厚分别为基线时5.5mm和第52周时3.5mm。两名患者必须接受结肠切除术(平均4.5个月,范围3-6)和三个由于无效而停止了ustekinumab治疗。总的来说,联合治疗耐受性良好.
■环孢菌素和ustekinumab联合治疗使近一半的ASUC患者在52周后达到临床和内镜缓解,值得进一步研究。
■不适用。
环孢菌素和ustekinumab联合治疗急性重度溃疡性结肠炎的效果,我们研究了如何治疗患有严重溃疡性结肠炎的患者,一种炎症性肠病,当通常的治疗不起作用时。我们测试了两种药物的组合,环孢素和ustekinumab,看看它是否能长期帮助这些患者。我们包括11名患者,他们已经尝试了许多其他治疗方法,但没有好转。他们中的大多数人还尝试了一种名为英夫利昔单抗的药物,并且至少在其他三种生物疗法中都失败了。一开始,这些病人病得很重,在疾病活动措施上得分很高。在之前开始使用环孢菌素治疗后,我们补充给了他们ustekinumab。联合治疗持续平均近12周。16周后,六名患者的症状有所改善,五个人停止服用类固醇.当我们在16周后用显微镜观察时,五名患者的结肠内膜看起来也很健康。52周后,5例患者在显微镜下具有正常的结肠衬里和健康的组织。超声显示其结肠壁厚度有所减小。不幸的是,两名患者不得不接受手术切除结肠,三个人不得不停止服用ustekinumab,因为这对他们没有帮助。总的来说,联合治疗是安全且耐受性良好的.总之,环孢菌素和ustekinumab的联合治疗有助于约一半的重度溃疡性结肠炎患者在52周后好转并有健康的结肠衬里.这表明需要更多的研究来了解这种治疗对这些患者的益处。
UNASSIGNED: Effective management of patients with acute severe ulcerative colitis (ASUC) is a major challenge and there remains a paucity of available maintenance treatment options after efficacious
cyclosporin induction therapy.
UNASSIGNED: We investigated the long-term effectiveness and safety of
cyclosporin and ustekinumab combination therapy in patients with steroid refractory ASUC.
UNASSIGNED: Monocentric, prospective study.
UNASSIGNED: We included patients with steroid refractory ASUC with multiple failed prior advanced therapies, who were treated with cyclosporin and ustekinumab combination therapy.
UNASSIGNED: Among the 11 included patients, 10 had prior failure to infliximab and 8 failed at least three previous biological therapies. The mean baseline Mayo and Lichtiger scores were 10.9 (9-12) and 13.3 (11-14), respectively. Ustekinumab was initiated 3.2 weeks (1-8) after initiation of cyclosporin treatment and combination therapy was continued for a mean of 11.5 (4-20) weeks. Clinical response was achieved in six patients at week 16 and clinical steroid-free clinical remission in five patients at week 48. Endoscopic remission was achieved in five patients at week 16 and together with histological remission in five patients at week 52. Intestinal ultrasound demonstrated mean bowel wall thickening in the sigmoid colon of 5.5 mm at baseline and 3.5 mm at week 52, respectively. Two patients had to undergo colectomy (mean 4.5 months, range 3-6) and three stopped ustekinumab therapy due to ineffectiveness. Overall, combination therapy was well tolerated.
UNASSIGNED: Combination of
cyclosporin and ustekinumab therapy allowed nearly half of ASUC patients to reach clinical and endoscopic remission after 52 weeks, warranting further studies.
UNASSIGNED: Not applicable.
Effects of
cyclosporin and ustekinumab combination therapy in acute severe ulcerative colitis In this study, we looked at how to treat patients with a severe form of ulcerative colitis, a type of inflammatory bowel disease, when the usual treatments don’t work. We tested a combination of two drugs, cyclosporine and ustekinumab, to see if it could help these patients in the long term. We included eleven patients who had already tried many other treatments and didn’t get better. Most of them had also tried a drug called infliximab and had failed at least three other biological therapies. At the start, these patients were very sick, with high scores on disease activity measures. We gave them ustekinumab in addtion after a therapy with
cyclosporin had been started before. The combination therapy continued for an average of almost 12 weeks. After 16 weeks, six patients showed improvement in their symptoms, and five were able to stop taking steroids. Five patients also had their colon lining looking healthy again when we looked inside with a scope after 16 weeks. And after 52 weeks, five patients had normal colon lining and healthy tissue under the microscope. Ultrasound showed that the thickness of their colon wall had decreased. Unfortunately, two patients had to have surgery to remove their colon, and three had to stop taking ustekinumab because it didn’t help them. Overall, the combination therapy was safe and well-tolerated. In conclusion, combining cyclosporin and ustekinumab helped about half of the patients with severe ulcerative colitis get better and have healthy colon lining after 52 weeks. This suggests that more research is needed to understand the benefits of this treatment in these patients.