📇 Rhumatologue · AURILLAC · (15) · Libéral
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Articles déposés en accès libre sur l'archive ouverte des universités françaises (HAL) — gage d'activité de recherche en France.
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CENTRE MEDICO CHIRURGICAL TRONQUIERES
83 AV CHARLES DE GAULLE BP 349, 15000 AURILLAC
CABINET DU DR CATHERINE COLLIN
CENTRE MEDICO CHIRURGICAL 83 AVENUE CHARLES DE GAULLE, 15000 AURILLAC
CH HENRI MONDOR
50 AV DE LA REPUBLIQUE BP 229, 15002 AURILLAC CEDEX
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Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2023
Alimentary pharmacology & therapeutics · 2021
SummaryBackgroundThe best option between vedolizumab and ustekinumab after anti‐tumour necrosis factor (TNF) failure remains unclear in Crohn's disease.AimsTo compare the short‐ and long‐term effectiveness of vedolizumab and ustekinumab in Crohn's disease patients with prior anti‐TNF exposure.MethodsAll Crohn's disease patients treated with ustekinumab or vedolizumab after exposure to at least one anti‐TNF agent were included from two referral centres. Primary endpoint was corticosteroid‐free clinical remission defined as Crohn's disease activity index <150 at week 54. Deep remission (corticosteroid‐free clinical remission and faecal calprotectin <100 µg/g) was assessed at week 14. Propensity‐matched analyses were applied to make the two groups comparable.ResultsOverall, 312 patients (ustekinumab = 224 and vedolizumab = 88) were included. After propensity score analysis, ustekinumab was more effective to achieve corticosteroid‐free clinical remission at week 54 (49.3% vs 41.2%, P = 0.04) and deep remission at Week 14 (25.9% vs 3.8%, P = 0.02) than vedolizumab. The rate of primary nonresponders (6.7% vs 14.8%, P = 0.034) and the long‐term risk of drug discontinuation due to therapeutic failure (HR = 1.53 [1.04‐2.07], P = 0.029) were lower in patients treated with ustekinumab compared with vedolizumab. Predictors of ustekinumab failure were complicated phenotype (odds ratio [OR] = 2.35 [1.31‐4.22]; P = 0.004) and anti‐TNF primary non‐response (OR = 2.55 [1.27‐5.12]; P = 0.008). We did not find any predictor of corticosteroid‐free clinical remission in patients treated with vedolizumab. Vedolizumab was less effective than ustekinumab in patients >35 years old (OR = 0.41 [0.19‐0.87]), with noncomplicated phenotype (OR=0.42 [0.18‐0.96]), no prior bowel resection (OR = 0.49 [0.24‐0.96]), and no steroids at baseline (OR=0.47 [0.23‐0.97]).ConclusionUstekinumab was more effective to achieve early and long‐term effectiveness than vedolizumab in Crohn's disease patients who previously failed response to anti‐TNF agents.
United European gastroenterology journal · 2021
AbstractBackgroundPreventing postoperative recurrence (POR) is a major concern in Crohn's disease (CD). While azathioprine is an option, no data is available on ustekinumab efficacy in this situation.AimsWe compared the effectiveness of ustekinumab versus azathioprine in preventing endoscopic POR in CD.MethodsWe retrospectively collected data from all consecutive CD patients treated with ustekinumab after intestinal resection in 9 centers. The control group (azathioprine alone) was composed of patients who participated in a randomized controlled trial conducted in the same centers comparing azathioprine alone or in combination with curcumin. Propensity score analyses (inversed probability of treatment weighting = IPTW) were applied to compare the two groups. The primary endpoint was endoscopic POR (Rutgeerts' index ≥ i2) at 6 months.ResultsOverall, 32 patients were included in the ustekinumab group and 31 in the azathioprine group. The propensity score analysis was adjusted on the main risk factors (smoking, fistulizing phenotype, prior bowel resection, resection length >30 cm and ≥2 biologics before surgery) and thiopurines or ustekinumab exposure prior to surgery making the two arms comparable (∣d∣ < 0.2). After IPTW, the rate of endoscopic POR at 6 months was lower in patients treated with ustekinumab compared to azathioprine (28.0% vs. 54.5%, p = 0.029). After IPTW, the rates of i2b‐endoscopic POR (Rutgeerts' index ≥ i2b) and severe endoscopic POR (Rutgeerts' index ≥ i3) were 20.8% versus 42.5% (p = 0.066) and 16.9% versus 27.9% (p = 0.24), in the ustekinumab and azathioprine groups, respectively.ConclusionUstekinumab seemed to be more effective than azathioprine in preventing POR in this cohort of CD patients.
Source PubMed · Recherche par auteur (homonymes possibles, vérifier l'affiliation).
United European gastroenterology journal · 2021 · Comparative Study
Buisson A, Nancey S, Manlay L, Rubin DT, et al.
Alimentary pharmacology & therapeutics · 2021 · Journal Article
Manlay L, Boschetti G, Pereira B, Flourié B, et al.
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2023 · Multicenter Study
Buisson A, Nachury M, Reymond M, Yzet C, et al.
Inflammatory bowel diseases · 2023 · Journal Article
Buisson A, Blanco L, Manlay L, Reymond M, et al.