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Clinical response correlates with 4‐week postinjection ustekinumab concentrations in patients with moderate‐to‐severe psoriasis

(2020) BRITISH JOURNAL OF DERMATOLOGY. 182(2). p.390-397
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Abstract
Background Cost-effective use of biologicals is important. As drug concentrations have been linked to clinical outcomes, monitoring drug concentrations is a valuable tool to guide clinical decision-making. A concentration-response relationship for ustekinumab at trough is uncertain owing to the contradictory results reported. Objectives To investigate the relationship between 4-week postinjection ustekinumab concentrations and clinical response in patients with psoriasis. Methods Forty-nine patients with moderate-to-severe psoriasis treated with 45 mg or 90 mg ustekinumab every 12 weeks for >= 16 weeks were included. Ustekinumab serum concentrations and anti-ustekinumab antibodies were measured at week 4 after injection and disease severity was assessed by Psoriasis Area and Severity Index (PASI). Results At week 4 after injection, a significantly negative correlation was observed between ustekinumab concentrations and absolute PASI score up to 5 center dot 9 mu g mL(-1) (rho = -0 center dot 357, P = 0 center dot 032). Ustekinumab concentrations were higher in optimal responders (PASI <= 2) than in suboptimal responders (PASI > 2) (4 center dot 0 vs 2 center dot 8 mu g mL(-1), P = 0 center dot 036). The ustekinumab concentration threshold associated with optimal response was determined to be 3 center dot 6 mu g mL(-1) (area under the curve 0 center dot 71, sensitivity 86%, specificity 63%). Only one patient (2%) had anti-ustekinumab antibodies. Psoriatic arthritis was identified as an independent predictor of higher PASI scores and higher ustekinumab concentrations (P = 0 center dot 003 and P = 0 center dot 048, respectively). Conclusions A concentration-response relationship at week 4 after injection was observed for patients with psoriasis treated with ustekinumab. Monitoring 4-week postinjection ustekinumab concentrations could timely identify underexposed patients who might benefit from treatment optimization. What's already known about this topic? Monitoring drug concentrations is a valuable tool that can guide clinical decision-making when drug concentrations are linked to clinical outcomes. The presence of a concentration-response relationship for ustekinumab at trough is still debated owing to the contradictory results reported. What does this study add? A concentration-response relationship at week 4 after injection for ustekinumab-treated patients with psoriasis was demonstrated. Monitoring 4-week postinjection ustekinumab concentrations could timely identify underexposed patients who might benefit from treatment optimization. Based on the findings of this study, a treatment algorithm for patients with a suboptimal response is proposed.
Keywords
Dermatology, INTERLEUKIN-12/23 MONOCLONAL-ANTIBODY, LONG-TERM EFFICACY, DOUBLE-BLIND, ADALIMUMAB, SAFETY, INFLIXIMAB, PASI

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MLA
Van den Berghe, N., et al. “Clinical Response Correlates with 4‐week Postinjection Ustekinumab Concentrations in Patients with Moderate‐to‐severe Psoriasis.” BRITISH JOURNAL OF DERMATOLOGY, vol. 182, no. 2, 2020, pp. 390–97.
APA
Van den Berghe, N., De Keyser, E., Soenen, R., Meuleman, L., Lanssens, S., Gils, A., & Lambert, J. (2020). Clinical response correlates with 4‐week postinjection ustekinumab concentrations in patients with moderate‐to‐severe psoriasis. BRITISH JOURNAL OF DERMATOLOGY, 182(2), 390–397.
Chicago author-date
Van den Berghe, N., Eline De Keyser, Rani Soenen, L. Meuleman, S. Lanssens, A. Gils, and Jo Lambert. 2020. “Clinical Response Correlates with 4‐week Postinjection Ustekinumab Concentrations in Patients with Moderate‐to‐severe Psoriasis.” BRITISH JOURNAL OF DERMATOLOGY 182 (2): 390–97.
Chicago author-date (all authors)
Van den Berghe, N., Eline De Keyser, Rani Soenen, L. Meuleman, S. Lanssens, A. Gils, and Jo Lambert. 2020. “Clinical Response Correlates with 4‐week Postinjection Ustekinumab Concentrations in Patients with Moderate‐to‐severe Psoriasis.” BRITISH JOURNAL OF DERMATOLOGY 182 (2): 390–397.
Vancouver
1.
Van den Berghe N, De Keyser E, Soenen R, Meuleman L, Lanssens S, Gils A, et al. Clinical response correlates with 4‐week postinjection ustekinumab concentrations in patients with moderate‐to‐severe psoriasis. BRITISH JOURNAL OF DERMATOLOGY. 2020;182(2):390–7.
IEEE
[1]
N. Van den Berghe et al., “Clinical response correlates with 4‐week postinjection ustekinumab concentrations in patients with moderate‐to‐severe psoriasis,” BRITISH JOURNAL OF DERMATOLOGY, vol. 182, no. 2, pp. 390–397, 2020.
@article{8661014,
  abstract     = {Background Cost-effective use of biologicals is important. As drug concentrations have been linked to clinical outcomes, monitoring drug concentrations is a valuable tool to guide clinical decision-making. A concentration-response relationship for ustekinumab at trough is uncertain owing to the contradictory results reported.

Objectives To investigate the relationship between 4-week postinjection ustekinumab concentrations and clinical response in patients with psoriasis.

Methods Forty-nine patients with moderate-to-severe psoriasis treated with 45 mg or 90 mg ustekinumab every 12 weeks for >= 16 weeks were included. Ustekinumab serum concentrations and anti-ustekinumab antibodies were measured at week 4 after injection and disease severity was assessed by Psoriasis Area and Severity Index (PASI).

Results At week 4 after injection, a significantly negative correlation was observed between ustekinumab concentrations and absolute PASI score up to 5 center dot 9 mu g mL(-1) (rho = -0 center dot 357, P = 0 center dot 032). Ustekinumab concentrations were higher in optimal responders (PASI <= 2) than in suboptimal responders (PASI > 2) (4 center dot 0 vs 2 center dot 8 mu g mL(-1), P = 0 center dot 036). The ustekinumab concentration threshold associated with optimal response was determined to be 3 center dot 6 mu g mL(-1) (area under the curve 0 center dot 71, sensitivity 86%, specificity 63%). Only one patient (2%) had anti-ustekinumab antibodies. Psoriatic arthritis was identified as an independent predictor of higher PASI scores and higher ustekinumab concentrations (P = 0 center dot 003 and P = 0 center dot 048, respectively).

Conclusions A concentration-response relationship at week 4 after injection was observed for patients with psoriasis treated with ustekinumab. Monitoring 4-week postinjection ustekinumab concentrations could timely identify underexposed patients who might benefit from treatment optimization.

What's already known about this topic?

Monitoring drug concentrations is a valuable tool that can guide clinical decision-making when drug concentrations are linked to clinical outcomes.

The presence of a concentration-response relationship for ustekinumab at trough is still debated owing to the contradictory results reported.

What does this study add?

A concentration-response relationship at week 4 after injection for ustekinumab-treated patients with psoriasis was demonstrated.

Monitoring 4-week postinjection ustekinumab concentrations could timely identify underexposed patients who might benefit from treatment optimization.

Based on the findings of this study, a treatment algorithm for patients with a suboptimal response is proposed.},
  author       = {Van den Berghe, N. and De Keyser, Eline and Soenen, Rani and Meuleman, L. and Lanssens, S. and Gils, A. and Lambert, Jo},
  issn         = {0007-0963},
  journal      = {BRITISH JOURNAL OF DERMATOLOGY},
  keywords     = {Dermatology,INTERLEUKIN-12/23 MONOCLONAL-ANTIBODY,LONG-TERM EFFICACY,DOUBLE-BLIND,ADALIMUMAB,SAFETY,INFLIXIMAB,PASI},
  language     = {eng},
  number       = {2},
  pages        = {390--397},
  title        = {Clinical response correlates with 4‐week postinjection ustekinumab concentrations in patients with moderate‐to‐severe psoriasis},
  url          = {http://dx.doi.org/10.1111/bjd.18016},
  volume       = {182},
  year         = {2020},
}

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