Artículo
Comprando el artículo el PDF del mismo podrá ser descargado
Precio 19,34 €
Comprar ahora
array:22 [ "pii" => "S0210570521001709" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2021.04.012" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "1823" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Gastroenterol Hepatol. 2022;45:735-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:19 [ "pii" => "S0210570522000796" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2022.02.005" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "1921" "copyright" => "The Authors" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Gastroenterol Hepatol. 2022;45:724-34" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Metabolic-associated fatty liver disease: From simple steatosis toward liver cirrhosis and potential complications. Proceedings of the <span class="elsevierStyleItalic">Third Translational Hepatology Meeting</span>, organized by the Spanish Association for the Study of the Liver (AEEH)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "724" "paginaFinal" => "734" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rocío Gallego-Durán, Agustín Albillos, Javier Ampuero, María Arechederra, Rafael Bañares, Ana Blas-García, Genoveva Berná, Esther Caparrós, Teresa C. Delgado, Juan Manuel Falcón-Pérez, Rubén Francés, Maite G. Fernández-Barrena, Isabel Graupera, Paula Iruzubieta, Yulia A. Nevzorova, Rubén Nogueiras, Rocío I.R. Macías, Franz Martín, Guadalupe Sabio, Germán Soriano, Javier Vaquero, Francisco Javier Cubero, Jordi Gracia-Sancho" "autores" => array:23 [ 0 => array:2 [ "nombre" => "Rocío" "apellidos" => "Gallego-Durán" ] 1 => array:2 [ "nombre" => "Agustín" "apellidos" => "Albillos" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Ampuero" ] 3 => array:2 [ "nombre" => "María" "apellidos" => "Arechederra" ] 4 => array:2 [ "nombre" => "Rafael" "apellidos" => "Bañares" ] 5 => array:2 [ "nombre" => "Ana" "apellidos" => "Blas-García" ] 6 => array:2 [ "nombre" => "Genoveva" "apellidos" => "Berná" ] 7 => array:2 [ "nombre" => "Esther" "apellidos" => "Caparrós" ] 8 => array:2 [ "nombre" => "Teresa C." "apellidos" => "Delgado" ] 9 => array:2 [ "nombre" => "Juan Manuel" "apellidos" => "Falcón-Pérez" ] 10 => array:2 [ "nombre" => "Rubén" "apellidos" => "Francés" ] 11 => array:2 [ "nombre" => "Maite G." "apellidos" => "Fernández-Barrena" ] 12 => array:2 [ "nombre" => "Isabel" "apellidos" => "Graupera" ] 13 => array:2 [ "nombre" => "Paula" "apellidos" => "Iruzubieta" ] 14 => array:2 [ "nombre" => "Yulia A." "apellidos" => "Nevzorova" ] 15 => array:2 [ "nombre" => "Rubén" "apellidos" => "Nogueiras" ] 16 => array:2 [ "nombre" => "Rocío I.R." "apellidos" => "Macías" ] 17 => array:2 [ "nombre" => "Franz" "apellidos" => "Martín" ] 18 => array:2 [ "nombre" => "Guadalupe" "apellidos" => "Sabio" ] 19 => array:2 [ "nombre" => "Germán" "apellidos" => "Soriano" ] 20 => array:2 [ "nombre" => "Javier" "apellidos" => "Vaquero" ] 21 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Cubero" ] 22 => array:2 [ "nombre" => "Jordi" "apellidos" => "Gracia-Sancho" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570522000796?idApp=UINPBA00004N" "url" => "/02105705/0000004500000009/v1_202211031708/S0210570522000796/v1_202211031708/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Rescue therapy with oral cyclosporine after use of ustekinumab in ulcerative colitis resistant to multiple treatments" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "735" "paginaFinal" => "736" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pablo Ladrón Abia, Alejandro Minguez Sabater, Esteban Sáez González, Belén Beltrán Niclós" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Pablo" "apellidos" => "Ladrón Abia" "email" => array:1 [ 0 => "paul199340@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Minguez Sabater" ] 2 => array:2 [ "nombre" => "Esteban" "apellidos" => "Sáez González" ] 3 => array:2 [ "nombre" => "Belén" "apellidos" => "Beltrán Niclós" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Gastroenterología y Hepatología del Hospital Universitario y Politécnico la Fe, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia de rescate con ciclosporina oral tras el uso de ustekinumab en colitis ulcerosa resistente a múltiples tratamientos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1126 "Ancho" => 2341 "Tamanyo" => 183695 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of faecal calprotectin (μg/g) and CRP (mg/L).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ulcerative colitis (UC) is an intermittent chronic pathology of the colon characterised by continuous inflammation of the mucosa that affects the rectum and, subsequently, the rest of the colon. Various cytokines (interleukin [IL]-12, tumour necrosis factor [TNF]-α, interferon-γ, IL-23) have been implicated in the pathogenesis of UC.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Selective targeting of pro-inflammatory cytokines with biological therapies is the main therapeutic approach. The recent UNIFI study has shown ustekinumab to be useful for inducing remission and maintenance in patients with UC.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Ustekinumab is a human monoclonal antibody that binds to the shared p40 protein subunit of IL-12 and IL-23, and it has been found to be useful as rescue therapy in refractory patients. We present a case of UC treated with ustekinumab in combination with cyclosporine as rescue therapy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 42-year-old woman was diagnosed with steroid-dependent UC pancolitis in 2012. Initially, she developed an acute pancreatitis secondary to azathioprine. She started infliximab but due to a secondary failure, was replaced by adalimumab.</p><p id="par0015" class="elsevierStylePara elsevierViewall">After one year, the patient presented an outbreak with osteoarticular symptoms, leading to the withdrawal of adalimumab and the start of golimumab, with subsequent loss of response and severe endoscopic activity. Vedolizumab was started and clinical remission was achieved during 3 years.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A severe UC outbreak caused the initiation of tofacitinib, but it was withdrawn due to the appearance of dyspnoea and cough, suspecting a pulmonary thromboembolism, which was subsequently ruled out. After ceasing treatment, a severe outbreak required intravenous steroid therapy and admission. A colonoscopy showed a severe flare, with UCEIS of 7. Colectomy was recommended due to steroid resistance and patient's status, but the patient dismissed the surgical option.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally, an intravenous induction dose of 6<span class="elsevierStyleHsp" style=""></span>mg/kg of ustekinumab was administered. Five days after induction, no clear improvement had occurred (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Due to steroid resistance, previous failure of anti TNF drugs and knowing that studies had reported ustekinumab results appeared at week 8,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> we started oral cyclosporine (4<span class="elsevierStyleHsp" style=""></span>mg/kg/12<span class="elsevierStyleHsp" style=""></span>h) as a rescue therapy. An early clinical response was observed with an acute drop in inflammatory parameters (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient was discharged 10 days after starting cyclosporine. Cyclosporine was removed progressively, reducing by 100<span class="elsevierStyleHsp" style=""></span>mg every 2 weeks until the steroids were completely tapered. The second dose of ustekinumab was administered the same day the patient finished the steroids, 8 weeks after the induction, achieving FC normalisation. From that moment on, cyclosporine was tapered by 50<span class="elsevierStyleHsp" style=""></span>mg every week, and its removal was coincident with the third dose of ustekinumab (ustekinumab levels before this third dose were 1.8<span class="elsevierStyleHsp" style=""></span>μg/ml). Four weeks later, while on monotherapy, she presented a clinical worsening and FC began to rise. Given the levels of ustekinumab were in the low range and the available evidence about the need and efficacy of ustekinumab treatment intensification,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> we reintroduced 6<span class="elsevierStyleHsp" style=""></span>mg/kg intravenous ustekinumab and intensified maintenance treatment to every 4 weeks. The aim was to attempt to keep ustekinumab for maintenance. Eight weeks after intensification, the patient reached clinical remission, ustekinumab levels of 15 mcg/l and normalisation of the inflammatory parameters (CRP 2.7<span class="elsevierStyleHsp" style=""></span>mg/l and FC 36.2<span class="elsevierStyleHsp" style=""></span>μg/g). One year after starting ustekinumab, the patient is asymptomatic, FC 22<span class="elsevierStyleHsp" style=""></span>μg/ml, ustekinumab levels of 7.9<span class="elsevierStyleHsp" style=""></span>mcg/ml, and mucosal healing.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Some recent studies have shown that ustekinumab is a safe and effective treatment option for refractory moderate-to-severe UC.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></a> The UNIFI study had determined that ustekinumab reaches a clinical response of 57.2% at week 8 of administration of an intravenous induction dose of 6<span class="elsevierStyleHsp" style=""></span>mg/kg.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Here we present a clinical case in which ustekinumab was used for a steroid-resistant severe flare of UC that had previously failed multiple therapies. There is little evidence in clinical practice on the efficacy of ustekinumab in such an acute flare.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">With this case we suggest that achieving remission requires higher levels of ustekinumab, at least in these refractory situations. Similarly, we should note that combined therapies can be taken into consideration, especially when severe situations arise, such as steroid resistance in a multi-failure scenario. We hypothesise that the inflammatory burden could be limiting the response to drugs. In this scenario, the need for combined therapies that could affect various immunological pathways concomitantly, could be an option to facilitate consistent drug efficacy but also prevent a therapeutic line loss.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1126 "Ancho" => 2341 "Tamanyo" => 183695 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of faecal calprotectin (μg/g) and CRP (mg/L).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Innate and adaptive immunity in inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Geremia" 1 => "P. Biancheri" 2 => "P. Allan" 3 => "G.R. Corazza" 4 => "A. Di Sabatino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2013.06.004" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2014" "volumen" => "13" "paginaInicial" => "3" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23774107" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ustekinumab as induction and maintenance therapy for ulcerative colitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.E. Sands" 1 => "W.J. Sandborn" 2 => "R. Panaccione" 3 => "C.D. O’Brien" 4 => "H. Zhang" 5 => "J. Johanns" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1900750" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2019" "volumen" => "381" "paginaInicial" => "1201" "paginaFinal" => "1214" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31553833" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of ustekinumab dose escalation in Crohn's disease patients with insufficient response to standard-dose subcutaneous maintenance therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "U. Kopylov" 1 => "J. Hanzel" 2 => "C. Liefferinckx" 3 => "D. De Marco" 4 => "N. Imperatore" 5 => "N. Plevris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/apt.15784" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2020" "volumen" => "52" "paginaInicial" => "135" "paginaFinal" => "142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32412134" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical outcomes with ustekinumab as rescue treatment in therapy-refractory or therapy-intolerant ulcerative colitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Ochsenkuhn" 1 => "C. Tillack" 2 => "D. Szokodi" 3 => "S. Janelidze" 4 => "F. Schnitzler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2050640619895361" "Revista" => array:6 [ "tituloSerie" => "United European Gastroenterol J" "fecha" => "2020" "volumen" => "8" "paginaInicial" => "91" "paginaFinal" => "98" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32213052" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful cyclosporin and ustekinumab combination therapy in a patient with severe steroid-refractory ulcerative colitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Ganzleben" 1 => "C. Geppert" 2 => "L. Osaba" 3 => "S. Hirschmann" 4 => "A. Nägel" 5 => "C. Glück" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Therap Adv Gastroenterol" "fecha" => "2020" "volumen" => "13" "numero" => "October" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105705/0000004500000009/v1_202211031708/S0210570521001709/v1_202211031708/en/main.assets" "Apartado" => array:4 [ "identificador" => "94802" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Carta al director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/02105705/0000004500000009/v1_202211031708/S0210570521001709/v1_202211031708/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570521001709?idApp=UINPBA00004N" ]
Consulte los artículos y contenidos publicados en este medio, además de los e-sumarios de las revistas científicas en el mismo momento de publicación
Esté informado en todo momento gracias a las alertas y novedades
Acceda a promociones exclusivas en suscripciones, lanzamientos y cursos acreditados
La misión de Gastroenterología y Hepatología es dar cobertura a una amplia gama de temas relacionados con la gastroenterología y hepatología, incluidos los avances más recientes en la patología del tubo digestivo, enfermedad inflamatoria intestinal, hígado, páncreas y vías biliares, siendo una herramienta indispensable para gastroenterólogos, hepatólogos, cirujanos, internistas y médicos generalistas, ofreciendo revisiones exhaustivas y actualizaciones de temas relacionados con la especialidad.
Además de los manuscritos con revisión científica externa sistemática, rigurosamente seleccionados, que se publican en las secciones de investigación (artículos de investigación, cartas científicas, editoriales y cartas al director), la revista también publica guías clínicas y documentos de consenso de las principales sociedades científicas. Es la revista oficial de la Asociación Española de Gastroenterología (AEG), de la Asociación Española para el Estudio del Hígado (AEEH), del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) y de la Sociedad Española de Enfermedad Celíaca (CEEC). La publicación está incluida en Medline/Pubmed, en el Science Citation Index Expanded, y en SCOPUS.
SCIE/Journal of Citation Reports, Index Medicus/Medline, Excerpta Medica/EMBASE, SCOPUS, CANCERLIT, IBECS
Ver másEl factor de impacto mide la media del número de citaciones recibidas en un año por trabajos publicados en la publicación durante los dos años anteriores.
© Clarivate Analytics, Journal Citation Reports 2022
SJR es una prestigiosa métrica basada en la idea de que todas las citaciones no son iguales. SJR usa un algoritmo similar al page rank de Google; es una medida cuantitativa y cualitativa al impacto de una publicación.
Ver másSNIP permite comparar el impacto de revistas de diferentes campos temáticos, corrigiendo las diferencias en la probabilidad de ser citado que existe entre revistas de distintas materias.
Ver másGastroenterología y Hepatología sigue las recomendaciones para la preparación, presentación y publicación de trabajos académicos en revistas biomédicas
¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?
Are you a health professional able to prescribe or dispense drugs?
Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos