P2563 - Efficacy of Dose Escalation of Ustekinumab in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Mohammad Ebad Ur Rehman, MBBS¹, Abdul Qadeer Khan, MBBS², Maha Sajjad, MBBS³, Ammara Tahir, MBBS⁴, Abu Huraira Bin Gulzar, ⁵, Aizaz Ali, MBBS⁶, Amna Hussain, MBBS⁷, Fatimah Shahid, MBBS¹, Shahroon Zahid, MBBS⁸, Talha Bin. Yasin, MBBS⁹, Aqsa Bilal, MBBS¹⁰, Umara Rajput, MBBS¹¹, Tehreem Fatima, MBBS¹², Tehseen Haider, MBBS¹, Sajeel Saeed, MBBS¹, Hamza Shahram, MBBS¹, Nouman Shafique, MD^13
1Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan; ²Saidu Medical College Swat, Swat, North-West Frontier, Pakistan; ³King Edward Medical University, Lahore, Punjab, Pakistan; ⁴Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, Sindh, Pakistan; ⁵Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; ⁶Khyber Medical College, Peshawar, Mardan, North-West Frontier, Pakistan; ⁷Liaquat University of Medical and Health Science, Shahdadpur, Punjab, Pakistan; ⁸Pak Emirates Military Hospital, Rawalpindi, Taxila, Punjab, Pakistan; ⁹Fazaia Ruth Pfau Medical College, Bahawalpur, Punjab, Pakistan; ¹⁰Nishtar Medical University, Multan, Punjab, Pakistan; ¹¹Saidu Medical College Swat, Mingora (SWAT), North-West Frontier, Pakistan; ¹²Foundation University Medical College, Islamabad, Islamabad, Pakistan; ¹³AdventHealth Medical Group, AdventHealth, Orlando, FL

Introduction: Ustekinumab (UST), an IL-12/23 antagonist, has been approved for treating patients with inflammatory bowel disease (IBD). For patients with inadequate response or loss of response to UST, dose escalation may be a promising option. Our meta-analysis evaluates the efficacy of dose escalation (via interval shortening or intravenous reinduction) of UST in patients with IBD.

Methods: A systematic literature search was done on MEDLINE, Embase, Cochrane, and Clinicaltrials.gov from inception to June 01, 2024, using MeSH terms and keywords for ‘Inflammatory Bowel Disease’ and ‘Ustekinumab’. Outcomes of interest were clinical response, clinical remission, steroid-free remission, endoscopic response, endoscopic remission, remission of perianal disease, progression to surgery, and normalization of CRP and fecal calprotectin following dose escalation. The random-effects model with the Freeman Tukey double arcsine transformation was used to pool overall prevalence with 95% CI for dichotomous variables in MetaXL version 5.3.

Results: We included data from, 28 studies, containing 2,030 patients. The median age of the patients ranged from 21.5-51.5 years. The pooled prevalence of patients reporting clinical response was 55% (95% CI: 0.46-0.65, I²=91%). Clinical remission and steroid free remission were reported in 51% (95% CI: 0.42-0.59, I²=87%) and 54% (95% CI: 0.45-0.64, I²=84%), respectively. Endoscopic response and endoscopic remission were achieved in 54% (95% CI: 0.42-0.65, I²=82%) and 33% (95% CI: 0.24-0.42, I²=73%), respectively. The pooled prevalence of patients reporting normalization of CRP, progression to surgery, remission of perianal disease and decrease in fecal calprotectin were 42% (95% CI: 0.33-0.52, I²=84%), 8% (95% CI: 0.05-0.12, I²=57%), 32% (95% CI: 0.22-0.43, I²=39%) and 54% (95% CI: 0.41-0.61, I²=75%), respectively.

Discussion: The pooled real world data suggest that dose escalation of ustekinumab is an efficacious option, with clinical and endoscopic response being achieved in 55% and 54% of patients, respectively. Further research is warranted to identify specific populations that are likely to benefit the most from dose escalation.



Disclosures:


Mohammad Ebad Ur Rehman, MBBS¹, Abdul Qadeer Khan, MBBS², Maha Sajjad, MBBS³, Ammara Tahir, MBBS⁴, Abu Huraira Bin Gulzar, ⁵, Aizaz Ali, MBBS⁶, Amna Hussain, MBBS⁷, Fatimah Shahid, MBBS¹, Shahroon Zahid, MBBS⁸, Talha Bin. Yasin, MBBS⁹, Aqsa Bilal, MBBS¹⁰, Umara Rajput, MBBS¹¹, Tehreem Fatima, MBBS¹², Tehseen Haider, MBBS¹, Sajeel Saeed, MBBS¹, Hamza Shahram, MBBS¹, Nouman Shafique, MD¹³. P2563 - Efficacy of Dose Escalation of Ustekinumab in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.