Clinical decision support tool‐guided, selective intensive induction strategy of ustekinumab in patients with Crohn's disease: A multicenter cohort study

作者：Qing Li, Jian Tang, Zhaopeng Huang, Lishuo Shi, Xiao Lyu, Xue Min Chen, Wenjing Chen, An-Ying Xun, Qin Guo, Miao Li, Xiang Gao, Kang Chao · 发表于：Journal of Digestive Diseases · 年份：2024 · DOI：10.1111/1751-2980.13318 · 被引用次数：1 · 研究领域：Inflammatory Bowel Disease、Rheumatoid Arthritis Research and Therapies、Autoimmune and Inflammatory Disorders

OBJECTIVES: We aimed to evaluate the effectiveness and safety of clinical decision support tool (CDST)-guided initial selective intensive induction therapy (IIT) for patients with Crohn's disease (CD) who were treated with ustekinumab (UST) and to identify those most likely to benefit from IIT. METHODS: Patients with active CD were included in this multicenter retrospective study and were categorized as low-, intermediate-, and high-probability responders according to the UST-CDST. IIT was defined as intensive induction by two or three initial doses of weight-based intravenous UST administration. Patients treated with standard therapy (ST) served as controls. The primary end-point was corticosteroid-free clinical remission (CFCR) at Week 24. Secondary end-points included clinical remission, clinical response, endoscopic remission, endoscopic response, and C-reactive protein (CRP) normalization at Week 24. Propensity score adjustments was conducted to ensure comparability. RESULTS: A total of 296 patients were included. At Week 24, IIT was associated with higher rates of CFCR (72.3% vs 43.0%, p < 0.001), clinical remission (77.3% vs 47.1%, p < 0.001), clinical response (78.1% vs 60.1%, p = 0.001), endoscopic remission (26.1% vs 9.9%, p = 0.024), and endoscopic response (58.6% vs 36.9%, p = 0.018) in low-intermediate-probability responders compared with ST. CRP normalization was comparable between groups. No significant differences were found in any end-points in high-probabili...