Early intervention with Ustekinumab is associated with higher rates of clinical and endoscopic remission in patients with Crohn's disease

Tong Tu; Mengqi Chen; Manying Li; Linxin Liu; Zihan Chen; Jianming Lin; Baili Chen; Yao He; Minhu Chen; Zhirong Zeng; Xiaojun Zhuang

doi:10.1177/17562848241307596

Early intervention with Ustekinumab is associated with higher rates of clinical and endoscopic remission in patients with Crohn's disease

Therap Adv Gastroenterol. 2024 Dec 23:17:17562848241307596. doi: 10.1177/17562848241307596. eCollection 2024.

Authors

Tong Tu¹, Mengqi Chen¹, Manying Li², Linxin Liu³, Zihan Chen¹, Jianming Lin¹, Baili Chen¹, Yao He¹, Minhu Chen¹, Zhirong Zeng⁴, Xiaojun Zhuang⁴

Affiliations

¹ Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
² Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
³ Boji Pharmaceutical Research Center, Boji Medical Biotechnological Co. Ltd., Guangzhou, Guangdong, China.
⁴ Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou 510080, China.

Abstract

Background: Early biologic intervention after diagnosis has shown improved clinical and endoscopic outcomes in patients with Crohn's disease (CD), while very little is known about the effectiveness of early versus late administration of Ustekinumab (UST).

Objectives: We aimed to compare early versus late UST use in managing CD and identify potential predictors associated with clinical and endoscopic outcomes.

Design: This was a retrospective observational study.

Methods: This study included patients with CD who started UST treatment from 2020 to 2023 in our center. Clinical and endoscopic outcomes were compared between early stage (⩽24 months) and later-stage (>24 months) groups at 6 months after starting UST therapy, and clinical predictors associated with any of the outcomes were assessed by logistic regression model. Furthermore, time-to-event analyses were applied to observe CD-related prognosis during follow-up.

Results: This study included 237 patients with CD, with 44.3% (n = 105) starting UST at the early stage and 55.7% (n = 132) at the later stage. Patients with early UST use demonstrated significantly higher rates of clinical and endoscopic remissions as compared to those with late UST use at 6 months after treatment. After adjusting for disease-related factors using multivariate logistic regression analysis, active perianal disease and severe disease were negatively associated with clinical and endoscopic remission in both early and late UST use groups. Finally, early UST administration was associated with a more favorable long-term outcome in terms of overall hospitalization and treatment escalation during follow-up.

Conclusion: Starting UST therapy in the early stage of CD especially within the first 6 months was associated with high rates of clinical and endoscopic remission and a low rate of CD-related complications.

Keywords: Crohn’s disease; Ustekinumab; clinical remission; endoscopic remission.

Plain language summary

Early Ustekinumab intervention in CD What is already known? Early biological intervention (early anti-tumor necrosis factor and anti-integrins) had demonstrated improved clinical and endoscopic results in patients suffering from CD. What is new here? Starting UST therapy in the early stage of CD, especially within the first 6 months was associated with high rates of clinical and endoscopic remissions and a low rate of CD-related complications. What do the findings mean? These findings emphasized the significance of initiating UST therapy at an early stage in managing CD, aiding clinicians in making informed decisions about the timing of UST treatment within the disease trajectory.