P420 Long term efficacy of ustekinumab in Crohn's disease patients after vedolizumab failure
Melotti, L.(1);Dussias, N.K.(1);Belluzzi, A.(1);Salice, M.(1);Calabrese, C.(1);Rizzello, F.(1);Gionchetti, P.(1);
(1)University of Bologna, Dept of surgical and medical sciences, Bologna, Italy;
Background
Ustekinumab (UST) and vedolizumab (VDZ) are approved biologic therapies for moderate-to-severe Crohn's disease (CD). Data regarding their comparative efficacy in patients previously treated with anti-TNF agents are available. However, data is lacking regarding their long-term effectiveness after failure of a second or third-line biologic treatment. Our aim is to evaluate ustekinumab efficacy after swapping from vedolizumab therapy for primary or secondary failure.
Methods
We conducted a single-centre, retrospective study in CD patients treated with UST as third line biologic therapy who swapped from VDZ therapy upon failure between January 2019 and October 2021. We assessed clinical (HBI), laboratoristic (CRP), endoscopic (SES-CD) activity and use of steroids at the beginning of ustekinumab therapy and after 12 months of treatment. We also collected data regarding previous biologic treatments. Clinical remission was defined as HBI < 5, while clinical response was defined as a reduction of at least three points of HBI from baseline and/or the suspension of steroids.
Results
Of 43 patients treated with UST after VDZ failure, 26 had a minimum follow up of 12 months and were included in the study. All patients had previously been treated with antiTNF agents. After 12 months, 4 patients have suspended treatment for failure; among patients still on treatment, clinical remission was evident in 63% (n = 14) of cases, 13 of them were also in laboratoristic remission. Endoscopy at 12 months was available in 11/14 patients in clinical remission; of these, 6 (55%) were in endoscopic remission. In patients who did not achieve clinical remission, 18% (n = 4) obtained clinical response. The last 18% (n = 4) of patients persisted on therapy.
Conclusion
Ustekinumab seems to be a viable and effective therapeutic option in patients with failure to multiple prior biologic therapies, obtaining deep remission after 12 months of treatment in a large proportion of patients.