Beyond Anti-TNF: Is Ustekinumab a Better Choice in Crohn’s?

TOPLINE:Ustekinumab exhibited higher persistence rates as a second-line therapy than anti–tumour necrosis factor (anti-TNF) treatment in patients with Crohn’s disease. Clinical remission rates with ustekinumab improved progressively, reaching 100% by 5 years.

METHODOLOGY:Researchers conducted this retrospective observational study of a prospective database to compare the persistence rates of ustekinumab as a second-line treatment with those of anti-TNF and to assess remission status.They included 68 adult patients with Crohn’s disease (median age, 48.5 years; 54.41% men) who received ustekinumab after not responding to anti-TNF or vedolizumab treatment.Data were collected at treatment initiation, at 4, 8, 16, and 24 weeks, and at 12, 24, 36, 48, and 60 months, until March 2023 or ustekinumab discontinuation.The primary objective was the evaluation of ustekinumab persistence, clinical remission (defined as a Harvey-Bradshaw Index ≤ 4), and biologic remission (defined as a C-reactive protein level < 5 mg/dL and/or a faecal calprotectin level < 250 mg/kg).Overall, 60.29% of the patients received the recommended ustekinumab dose of 90 mg every 8 weeks, whereas 36.76% required dose optimisation.TAKEAWAY:Persistence rates were higher with ustekinumab than with anti-TNF therapy, being 93.2% vs 72.06% at 1 year, 89.4% vs 45.59% at 2 years, and 86.1% vs 30.88% at 3 years.Clinical remission with ustekinumab improved progressively from 40.63% at 4 weeks to 54.9% at 1 year, reaching 100% at 5 years.A significant reduction in faecal calprotectin values was also noted during follow-up (P = .0002).Among patients with perianal disease (n = 10), seven achieved clinical remission, and four patients had complete fistula healing at the end of follow-up.The mean duration of ustekinumab treatment was 27.65 months, with 86.76% of patients continuing ustekinumab after the end of follow-up; 13.24% of patients discontinued ustekinumab treatment due to primary non-response, loss of response, or adverse events.IN PRACTICE:"Ustekinumab may show a better persistence as second-line treatment compared to anti-TNF and may be effective in perianal disease," the authors wrote. SOURCE:This study was led by I. Latras-Cortés, University Hospital of León, León, Spain, and was published online on March 19, 2025, in Digestive Diseases and Sciences. LIMITATIONS:The single-centre design of this study limited the applicability of the findings to other healthcare settings. The retrospective data collection warranted a cautious interpretation of the findings. Additionally, a limited number of patients underwent colonoscopy for assessing mucosal healing. DISCLOSURES:This study did not receive any financial support. Four authors reported receiving support from AbbVie, Janssen, and Takeda to attend meetings. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.