811 Ustekinumab for Concomitant Crohn’s Disease and Psoriasis

Abstract

INTRODUCTION: Ustekinumab (CNTO 1275), approved for Crohn’s disease (CD) and psoriasis, acts by preventing the immune responses involved in the pathogenesis of CD and psoriasis. It is an IgG1 monoclonal antibody that blocks the activation of IL-12 and IL-23 by binding to their P40 subunits. The scope of this systematic review was to review the clinical effectiveness of Ustekinumab in the treatment of patients who have a concomitant diagnosis of CD and psoriasis. METHODS: A systematic literature search was conducted using MeSh terms on MEDLINE per PRISMA reporting guidelines. Following the PICO framework, research articles with patients having a concomitant diagnosis of Crohn’s disease and psoriasis, treated with Ustekinumab were included. Psoriatic subjects with CD were included, regardless of whether their psoriasis was primary or anti-TNF therapy induced. Study designs included were retrospective cohorts, prospective cohorts, clinical trials, case reports and case series due to the anticipated paucity of literature on the study topic. Studies on non-human subjects and not in English were excluded. RESULTS: Of the 45 studies identified by systematic searches, 8 studies (n = 206) met the inclusion criteria (Figure 1). Seventy five percent patients had concurrent CD and treatment induced psoriasis whereas the rest had concurrent CD and primary psoriasis. Inductions doses of Ustekinumab ranged from 45 mg to 90 mg subcutaneously; maintenance doses were 45 to 90 mg after every 12 weeks, subcutaneously. In this patient population with concomitant CD and psoriasis (Table 1), Ustekinumab was reported to be efficacious for treatment of CD, reducing Crohn’s disease activity index (CDAI) and Harvey Bradshaw index scores, while demonstrating improvement in clinical symptoms and ileocolonoscopy findings. Similarly, improvement in psoriasis was reported by reductions in psoriasis area and severity index (PASI) and clinical assessments of disease severity. CONCLUSION: Ustekinumab appears to be novel drug for the treatment of concurrent Crohn’s disease and psoriasis. However, the published literature is limited by its retrospective nature and the extremely limited availability of epidemiologic data for patients with concurrent Crohn’s and psoriasis. Considering the shared immuno-pathogenetic mechanisms governing CD and psoriasis, further investigation is needed on studying the efficacy and adverse effects of ustekinumab.