Long-term Maintenance of Clinical, Endoscopic, and Radiographic Response to Ustekinumab in Moderate-to-Severe Crohn's Disease: Real-world Experience from a Multicenter Cohort Study.
Ustekinumab is a monoclonal antibody targeting interleukins 12 and 23. While effective in clinical trials for Crohn's disease (CD), long-term maintenance of response in the real-world setting is unclear. We aim to assess the efficacy of ustekinumab for maintaining clinical, endoscopic, and radiographic response in CD.



A retrospective multicenter cohort study was performed on patients with CD achieving steroid-free clinical response to ustekinumab induction, and advanced onto a regularly scheduled maintenance ustekinumab regimen between 2011 and 2016. The primary outcome was loss of response, defined by an increase in Harvey Bradshaw Index of >3 points from baseline requiring ustekinumab dose escalation, reinduction, rescue corticosteroids, immunomodulators, surgery, or ustekinumab discontinuation. Multivariate Cox proportional hazards regression was used to identify clinical factors associated with loss of response.



One hundred four patients with CD achieving steroid-free response with ustekinumab induction were included; 92.3% (96/104) had previously failed antitumor necrosis factor therapy. Median follow-up was 57.2 weeks (interquartile range (IQR): 36.7-103.4). Cumulative probability of maintained response at 52 weeks was 71.8%. Sixty-seven patients (64.4%) maintained endoscopic or radiographic response. Thirty-five patients (33.7%) lost response at a median time of 47.4 weeks (IQR: 35.3-68.4). Dose escalation was required in 17 patients (16.3%); response was recaptured in 9/17 (52.9%). Nine patients (8.7%) required surgery. In Cox multivariate regression, concurrent immunomodulation was associated with reduced risk of loss of response (hazards ratio 0.39 (95% CI, 0.17-0.92)).



Subcutaneous ustekinumab is an effective treatment option for maintaining long-term clinical, endoscopic, and radiographic response in patients with moderate-to-severe CD failing antitumor necrosis factor therapy.
*Department of Medicine, Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada;†Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada;‡Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada; and§Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom.
Christopher
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Ma
Richard N
RN
Fedorak
Gilaad G
GG
Kaplan
Levinus A
LA
Dieleman
Shane M
SM
Devlin
Nathan
N
Stern
Karen I
KI
Kroeker
Cynthia H
CH
Seow
Yvette
Y
Leung
Kerri L
KL
Novak
Brendan P
BP
Halloran
Vivian W
VW
Huang
Karen
K
Wong
Philip K
PK
Blustein
Subrata
S
Ghosh
Remo
R
Panaccione
D000328:Adult; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D003879:Dermatologic Agents / Q000627:therapeutic use*; D019468:Disease Management; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D000069549:Ustekinumab / Q000627:therapeutic use*
D003879:Dermatologic Agents; D000069549:Ustekinumab