Demyelination in a patient receiving ustekinumab for refractory Crohn's disease

Extract

Dear Sir,

Ustekinumab is a monoclonal antibody targeting the common part of interleukins 12 and 23, which has proven its efficacy in Crohn's disease¹ and not in multiple sclerosis.² Prevalence of autoimmune diseases including demyelinating disorders is increased in patients with inflammatory bowel disease (IBD)³ and cases of demyelination have been observed in patients receiving TNF-α antagonist. We report here a case of demyelination in a patient with refractory Crohn's disease treated by ustekinumab.

A refractory stenotic ileal Crohn's disease was diagnosed in 1985 in a woman born in 1951. She experienced five small bowel resections from 1986 to 2004. Despite intensive medical treatments including azathioprine, methotrexate, infliximab, adalimumab and certolizumab, a sixth bowel resection was performed in 2009. On February 2010, she was enrolled in a randomized controlled trial comparing ustekinumab to placebo. After a primary response at week 6, she completed the placebo-controlled maintenance phase and was still responding at the end of the study period in October 2010. Since the end of the study, ustekinumab was continued as a compassionate drug, 90 mg every 12 weeks subcutaneously.