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In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.
Summary
A man in his 60s with penetrating ileocolonic Crohn’s disease (CD), recently started on ustekinumab therapy, presented with new onset dyspnoea, paroxysmal nocturnal dyspnoea and dependent oedema. He was diagnosed with heart failure (HF) 10 months after starting ustekinumab therapy. His symptoms resolved with discontinuation of ustekinumab and he had recovery of his cardiac function. Though initial studies that led to the U.S Food and Drug Administration (FDA)approval for ustekinumab did not detect a signal for HF, postmarketing surveillance has detected rare cases of HF after initiation of the medication. This is one of the few reported cases of HF associated with ustekinumab therapy for CD.
Background
Ustekinumab is a monoclonal antibody to the p40 subunit of interleukin (IL)-12 and IL-23,1 FDA approved for the treatment of Crohn’s disease (CD). Initial studies that led to FDA approval did not detect a signal for heart failure (HF). We present a rare case of HF after initiation of ustekinumab for CD with subsequent recovery of cardiac function after discontinuation of therapy and appropriate guideline-directed therapy for HF.
Case presentation
A man in his 60s with a history of Barrett’s oesophagus, stage 4 chronic kidney disease, recurrent deep vein thrombosis, chronic neuropathy and spondyloarthritis, presented with an enterocutaneous fistula and was diagnosed with penetrating ileocolonic CD. Medications at the time included pantoprazole, warfarin, duloxetine, pregabalin and nortriptyline.
Treatment was initiated with corticosteroids and anti-tumour necrosis factor (anti-TNF) adalimumab in combination with weight-based azathioprine. The patient achieved clinical remission on therapy but …
Footnotes
Contributors Supervised by RB. Patient was under the care of RB. Report was written by EM, BP and RB.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
First published Morgenweck E, Park B, Bower R. Heart failure associated with ustekinumab therapy for treatment of Crohn's Disease. BMJ Case Rep 2022;15:e250376.