Ustekinumab for the treatment of paradoxical skin reactions and cutaneous manifestations of inflammatory bowel diseases

Wu, Jessica; Smogorzewski, Jan

doi:10.1111/dth.14883

Cited by 20 publications

(17 citation statements)

References 43 publications

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“…UST is approved for moderate to severe CD and may be effective for dermatologic manifestations of CD for patients who have failed anti-TNF medications or developed paradoxical reactions to other biologic agents. 8 In a retrospective case series of patients who had failed immunomodulator and anti-TNF therapy for MCD, UST therapy led to remission in 5 cases and partial response in 4 cases with a median time to remission of 5 months. 9 Here, we report a case of MCD having improved with UST that failed both infliximab and adalimumab.…”

Section: Discussionmentioning

confidence: 99%

Refractory metastatic Crohn’s disease responsive to ustekinumab dose intensification

Xiao¹,

Ezenwa²,

Luzuriaga³

et al. 2023

JAAD Case Reports

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Section: Discussionmentioning

confidence: 99%

Refractory metastatic Crohn’s disease responsive to ustekinumab dose intensification

Xiao¹,

Ezenwa²,

Luzuriaga³

et al. 2023

JAAD Case Reports

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“…The IL-23 is a pro-inflammatory cytokine and is a key proinflammatory cytokine in the development of chronic inflammatory diseases, such as multiple sclerosis, rheumatoid arthritis, inflammatory bowel diseases, or psoriasis (Gaen et al, 2014;Schinocca et al, 2021). Increased levels of IL-23 have been found in biopsies from patients with psoriasis, Crohn's disease, and ulcerative colitis (Patel & Kuchroo, 2015;Riquelme et al, 2018;Wu & Smogorzewski, 2021).…”

Section: Discussionmentioning

confidence: 99%

Fermented food Tempeh induces interleukin 12 and enhances macrophage phagocytosis

et al. 2021

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Cytokines play an important role in maintaining the homeostasis of hematopoiesis, cell proliferation and differentiation, as well as the immune system consisting of innate and adaptive immunity in the body. Interleukin-12 (IL-12) is a member of the IL-12 family of cytokines. IL-12, which is secreted by phagocytic cells in response to pathogens, is a heterodimer protein of two subunits (p35 and p40) that acts primarily during the induction of Interferonγ (IFNγ) via the signal transducer and activator of transcription 4 (STAT4) in T and natural killer (NK) cells (Guo et al., 2019). IL-12 is a cytokine that strongly induces the Th1 response. Activated macrophages by IFNγ enhance phagocytosis and bactericidal activity (Masuda et al., 2010).

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“…The efficacy profiles of non-anti-TNF biologics may also influence treatment choice given that some may additionally treat EIMs of IBD. For example, while ustekinumab may be selected to treat UC or CD, it has also demonstrated efficacy in the treatment of paradoxical psoriasiform skin drug reactions and cutaneous manifestations of IBD ( 75 ).…”

Section: Options For the Therapeutic Management Of Non-response To An...mentioning

confidence: 99%

Management of Non-response and Loss of Response to Anti-tumor Necrosis Factor Therapy in Inflammatory Bowel Disease

et al. 2022

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Anti-tumor necrosis factor (anti-TNF) therapy has been successfully used as first-line biologic treatment for moderate-to-severe inflammatory bowel disease (IBD), in both “step-up” and “top-down” approaches, and has become a cornerstone of IBD management. However, in a proportion of patients the effectiveness of anti-TNF therapy is sub-optimal. Either patients do not achieve adequate initial response (primary non-response) or they lose response after initial success (loss of response). Therapeutic drug monitoring determines drug serum concentrations and the presence of anti-drug antibodies (ADAbs) and can help guide treatment optimization to improve patient outcomes. For patients with low drug concentrations who are ADAb-negative or display low levels of ADAbs, dose escalation is recommended. Should response remain unchanged following dose optimization the question whether to switch within class (anti-TNF) or out of class (different mechanism of action) arises. If ADAb levels are high and the patient has previously benefited from anti-TNF therapy, then switching within class is a viable option as ADAbs are molecule specific. Addition of an immunomodulator may lead to a decrease in ADAbs and a regaining of response in a proportion of patients. If a patient does not achieve a robust therapeutic response with an initial anti-TNF despite adequate drug levels, then switching out of class is appropriate. In conjunction with the guidance above, other factors including patient preference, age, comorbidities, disease phenotype, extra-intestinal manifestations, and treatment costs need to be factored into the treatment decision. In this review we discuss current evidence in this field and provide guidance on therapeutic decision-making in clinical situations.

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Ustekinumab for the treatment of paradoxical skin reactions and cutaneous manifestations of inflammatory bowel diseases

Cited by 20 publications

References 43 publications

Refractory metastatic Crohn’s disease responsive to ustekinumab dose intensification

Refractory metastatic Crohn’s disease responsive to ustekinumab dose intensification

Fermented food Tempeh induces interleukin 12 and enhances macrophage phagocytosis

Management of Non-response and Loss of Response to Anti-tumor Necrosis Factor Therapy in Inflammatory Bowel Disease

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