Ustekinumab shows potential therapeutic benefit in perianal Crohn's Disease

Use of ustekinumab appears effective in the treatment of perianal refractory Crohn’s disease (pCD), suggests a recent study.

A national multicentre retrospective cohort study was carried out involving patients with either active or inactive pCD who received ustekinumab. In patients with active pCD at treatment initiation, the success of ustekinumab was defined by clinical success at 6 months assessed by the physician’s judgment without additional medical or surgical treatment for pCD.

The authors performed univariate and multivariate logistic regression analyses to identify predictors of success. They also calculated the pCD recurrence-free survival in patients with inactive pCD at ustekinumab initiation using the Kaplan-Meier method.

In total, 207 patients (mean age, 37.7 years) were analysed. Participants had a mean CD duration of 14.3 years and mean number of prior perianal surgeries of 2.8. Of the patients, 205 (99 percent) had been previously exposed to at least one antitumour necrosis factor (anti-TNF) and 58 (28 percent) to vedolizumab. Median follow-up time was 48 weeks.

Fifty-six (27 percent) patients discontinued therapy after a median time of 43 weeks. Fifty-seven of 148 (38.5 percent) patients with active pCD achieved success. Among those with setons at initiation, 29 of 88 (33 percent) had a successful removal. Treatment success correlated with the absence of optimization (odds ratio [OR], 2.74, 95 percent confidence interval [CI], 0.96–7.82; p=0.044).

Multivariable analysis revealed that the number of prior anti-TNF (≥3) was borderline significant (OR, 0.4, 95 percent CI, 0.15–1.08; p=0.056).

Additionally, the odds of recurrence-free survival in patients with inactive pCD at initiation was 86.2 percent at week 26 and 75.1 percent at week 52.

“Further prospective studies are warranted,” the authors said.