Introduction: Ustekinumab (UST) is an IL-12/23p40 inhibitor approved for treatment of Crohn’s disease and ulcerative colitis (UC). In the UNIFI maintenance study of patients (pts) with moderate to severe UC, > 90% of pts who achieved clinical response or remission at week (wk) 44 were not receiving corticosteroids, an important therapeutic goal. In this analysis, we describe the corticosteroid-sparing effects of UST treatment through 4 years (yrs) among pts who were treated in the UNIFI long-term extension (LTE).
Methods: Overall, 523 intravenous UST induction responders were randomized to subcutaneous (SC) maintenance therapy (placebo [PBO], n=175; UST 90mg every 12 wks [q12w], n=172; or UST 90mg q8w, n=176). A total of 284 UST pts completed wk44 and were treated in the LTE. PBO pts were discontinued after study unblinding. Based on investigator’s clinical judgement of UC disease activity, pts in the LTE were eligible to receive a dose adjustment starting at wk56: PBO to q8w, q12w to q8w, and q8w to q8w (sham adjustment). Pts in PBO or q8w groups were only eligible for dose adjustment or sham dose adjustment before unblinding. Efficacy was evaluated using symptomatic remission (Mayo stool frequency subscore of 0 or 1 and a rectal bleeding subscore of 0).
During the maintenance study, all pts receiving corticosteroids at maintenance baseline were required to initiate tapering. Through wk200 of the LTE, symptomatic remission endpoints were calculated with treatment failure and missing data nonresponder imputation, and dose adjustment was not considered to be a treatment failure. Missing corticosteroid dose data were managed using last observation carried forward.
Results: Of the 284 pts randomized to UST and treated in the LTE, 139 were receiving corticosteroids at maintenance baseline. Of these, 79.1% (n=110) were no longer receiving corticosteroids at wk200. Rates of corticosteroid-free symptomatic remission at wk200 were generally similar for the q8w and q12w maintenance doses (Table 1). Of the UST-treated pts in symptomatic remission at wk200, 94/96 (97.9%) in the q12w group and 91/96 (94.8%) in the q8w group were corticosteroid free.
Discussion: UST maintenance therapy, with both q8w and q12w dosing regimens, was effective in reducing and eliminating the use of corticosteroids in pts with UC through 4 yrs. The majority of pts in symptomatic remission were corticosteroid free through 4 yrs of treatment with UST.
