Ustekinumab as Induction and Maintenance Therapy for Crohn’s Disease Academic Article uri icon

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abstract

  • BACKGROUND: Ustekinumab, a monoclonal antibody to the p40 subunit of interleukin-12 and interleukin-23, was evaluated as an intravenous induction therapy in two populations with moderately to severely active Crohn's disease. Ustekinumab was also evaluated as subcutaneous maintenance therapy. METHODS: We randomly assigned patients to receive a single intravenous dose of ustekinumab (either 130 mg or approximately 6 mg per kilogram of body weight) or placebo in two induction trials. The UNITI-1 trial included 741 patients who met the criteria for primary or secondary nonresponse to tumor necrosis factor (TNF) antagonists or had unacceptable side effects. The UNITI-2 trial included 628 patients in whom conventional therapy failed or unacceptable side effects occurred. Patients who completed these induction trials then participated in IM-UNITI, in which the 397 patients who had a response to ustekinumab were randomly assigned to receive subcutaneous maintenance injections of 90 mg of ustekinumab (either every 8 weeks or every 12 weeks) or placebo. The primary end point for the induction trials was a clinical response at week 6 (defined as a decrease from baseline in the Crohn's Disease Activity Index [CDAI] score of ≥100 points or a CDAI score <150). The primary end point for the maintenance trial was remission at week 44 (CDAI score <150). RESULTS: The rates of response at week 6 among patients receiving intravenous ustekinumab at a dose of either 130 mg or approximately 6 mg per kilogram were significantly higher than the rates among patients receiving placebo (in UNITI-1, 34.3%, 33.7%, and 21.5%, respectively, with P≤0.003 for both comparisons with placebo; in UNITI-2, 51.7%, 55.5%, and 28.7%, respectively, with P<0.001 for both doses). In the groups receiving maintenance doses of ustekinumab every 8 weeks or every 12 weeks, 53.1% and 48.8%, respectively, were in remission at week 44, as compared with 35.9% of those receiving placebo (P=0.005 and P=0.04, respectively). Within each trial, adverse-event rates were similar among treatment groups. CONCLUSIONS: Among patients with moderately to severely active Crohn's disease, those receiving intravenous ustekinumab had a significantly higher rate of response than did those receiving placebo. Subcutaneous ustekinumab maintained remission in patients who had a clinical response to induction therapy. (Funded by Janssen Research and Development; ClinicalTrials.gov numbers, NCT01369329 , NCT01369342 , and NCT01369355 .).

authors

  • Marshall, John Kenneth
  • Feagan, Brian G
  • Sandborn, William J
  • Gasink, Christopher
  • Jacobstein, Douglas
  • Lang, Yinghua
  • Friedman, Joshua R
  • Blank, Marion A
  • Johanns, Jewel
  • Gao, Long-Long
  • Miao, Ye
  • Adedokun, Omoniyi J
  • Sands, Bruce E
  • Hanauer, Stephen B
  • Vermeire, Severine
  • Targan, Stephan
  • Ghosh, Subrata
  • de Villiers, Willem J
  • Colombel, Jean-Frédéric
  • Tulassay, Zsolt
  • Seidler, Ursula
  • Salzberg, Bruce A
  • Desreumaux, Pierre
  • Lee, Scott D
  • Loftus, Edward V
  • Dieleman, Levinus A
  • Katz, Seymour
  • Rutgeerts, Paul

publication date

  • November 17, 2016