P462 Efficacy of ustekinumab for the prevention of postoperative recurrence in crohn’s disease. Data from clinical practice from the eneida registry
M. Mañosa Ciria1, A. Fernandez-Clotet2, A. Hernández-Camba3, R. Muñoz Pérez4, M. Iborra5, M. Sierra6, L. Márquez7, P. Delgado-Guillena8, D. Busquets9, M. Van Domselaar10, E. Girona11, E. Sánchez-Rodríguez12, M.D. Martín-Arranz13, R. Lorente14, D. Casas-Deza15, M. Boscá16, F. Cañete1, M. Calafat1, E. Domènech1
1Department of Gastroenterology CIBERehd- IBD Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Spain, 2Gastroenterology, Hospital Clinic Barcelona, Barcelona, Spain, 3Gastroenterology, Hospital Nuestra Señora de la Candelaria, Tenerife, Spain, 4Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain, 5Gastroenterology, Hospital La Fe, Valencia, Spain, 6Gastroenterology, Hospital Universitario de Leon, Leon, Spain, 7Gastroenterology, Hospital del mar, Barcelona, Spain, 8Gastroenterology, Hospital General de Granollers, Granollers, Spain, 9Gastroenterology, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain, 10Gastroenterology, Hospital de Torrejon, Torrejon, Spain, 11Gastroenterology, Hospital General Universitario de Elche, Elche, Spain, 12Gastroenterology, Hospital Ramon y Cajal, Madrid, Spain, 13Gastroenterology, Hospital la Paz, Madrid, Spain, 14Gastroenterology, Hospital de Ciudad Real, Ciudad Real, Spain, 15Gastroenetrology, Hospital Miguel Servet, Zaragoza, Spain, 16, Gastroenterology, Hospital Universitario Clínico de Valencia, Valencia, Spain
Background
Anti-TNF and thiopurines are the only drugs that demonstrated efficacy in preventing postoperative recurrence (POR) in Crohn’s disease (CD). However, in some cases these drugs are contraindicated or have previously failed. Recently, ustekinumab was licensed for CD but no data on its efficacy in the prevention of POR is still available.
Methods
All CD patients in whom ustekinumab was prescribed for primary prevention of POR within the first 3 months after ileocecal or ileocolonic resection with anastomosis were identified from the ENEIDA registry (a prospectively maintained database of the Spanish Working Group in IBD –GETECCU-). We evaluated the rates of endoscopic, clinical or surgical POR in the first 18 months. Endoscopic POR was defined by a Rutgeerts score >i1 and advanced endoscopic POR by >i2.
Results
Thirty patients were included; ustekinumab was started after a median time of 60 days (IIQ 31–90). Concomitant immunosuppressants were used in 17%, 27% received an additional 3-month course of metronidazole after surgery. Regarding risk factors for POR: 23% were active smokers, 62% had prior resections, 33% had penetrating CD behaviour, and 22% had a history of perianal disease. In total, 36% of them had more than one risk factor. 50% had been exposed to ustekinumab prior to the index surgery (46% within the last 6 months). The median time of follow-up on ustekinumab was 17 months (IQR 11–21). Fifty-six per cent of patients had at least one endoscopic assessment within 18 months after surgery: 58% had endoscopic POR and 23% advanced endoscopic POR. Additionally, 13% presented clinical POR at the discretion of the treating physician and none developed surgical POR.
Conclusion
In a small clinical practice cohort, ustekinumab showed similar efficacy as that reported with anti-TNF in the prevention of endoscopic POR. Unfortunately, the lack of early endoscopic monitoring is still frequent despite the recommendations from guidelines.