P047 PRELIMINARY EXPERIENCE WITH USTEKINUMAB IN CHILDREN AND YOUNG ADULTS WITH CROHN’S DISEASE

Le résumé fourni par la source

Pediatric Crohn’s disease poses challenges due to longer cumulative duration of disease and its effect on patient growth. A “top-down” approach, with early introduction of biologics, is common in pediatrics. Anti-TNF agents are commonly used, but anti-IL 12/23 antibody ustekinumab has recently emerged as an alternative for refractory Crohn’s treatment. We conducted a retrospective observational cohort study by doing a chart review of pediatric Crohn’s patients treated with ustekinumab at a tertiary free-standing pediatric hospital. Between 2016 and 2018, a total of 25 patients (13 females and 12 males, median age 16.2 years) received ustekinumab. Majority of patients had ileocolonic (n = 15, 60%), or colonic (n = 7, 30%) involvement. Stricturing or penetrating disease was present in 6 patients (24%), and perianal disease was present in 9 (36%). Five patients (20%) had a previous colorectal surgery. All 25 patients received an anti-TNF drug prior ustekinumab, of which 15 (60%) received more than one anti-TNF. Seven patients had a poor response to the first anti-TNF (not related to antibody formation), but still were treated with a second anti-TNF prior to switch to ustekinumab. At the time of starting ustekinumab, median duration of disease was 4.3 years. Compared to the 6 month period before ustekinumab induction, there was a decline of CRP from a median of 4.1 to 0.9 mg/dL; decline of ESR from a median of 55 to 39.5 mm/hr, decline of platelets from a median of 422 to 337 K/mcl and a median weight increase of 3% after ustekinumab induction. Median values for albumin and hemoglobin were similar before and after the induction (Albumin 3.2 vs. 3.3 gm/dL, Hemoglobin 10.7 vs. 11.1 gm/dL). Pediatric Crohn’s Disease Activity Index (PCDAI) data was available on 16 patients for whom it was calculated at a median of 22 days before and 177 days after ustekinumab induction. Of these, 7 (44%) had PCDAI improvement of >=12.5 (steroid-free), and 6 (38%) had an improvement of >=5 after ustekinumab induction. Seven patients (28%) required ustekinumab dose escalation to achieve or maintain response. During a median followup of 14 months since ustekinumab induction, no infectious complications or anaphylactic reactions have been reported. Two patients had poor response and underwent surgery within 6 months from induction. One patient died from unrelated causes. Ustekinumab appears to be a viable alternative in management of refractory pediatric Crohn’s disease. It also provides an alternative for patients with small bowel and perianal disease in whom vedolizumab may not be as effective. Ustekinumab may be considered sooner in patients who had primary poor response to the first anti-TNF drug (not due to antibody formation).

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