C0356 - Real World Ustekinumab Experience in Ileum-Dominant versus Colonic Crohn’s Disease

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Elvis Arteaga, MD

University of California, Davis
Sacramento, CA

Elvis Arteaga, MD¹, Eric J. Mao, MD¹, Sirisha Grandhe, MD², Nuen Tsang Yang, MS³
¹University of California, Davis, Sacramento, CA; ²Washington Gastroenterology, Bellevue, WA; ³University of California, Woodland, CA

Introduction: Crohn’s disease (CD) presents with diverse phenotypes, affecting the ileum, colon or both. There is literature to suggest that ileal or ileocolonic CD behaves differently than colonic CD. It remains unclear how different CD phenotypes impact response to therapy. The aim of this study was to compare the performance of ustekinumab in ileum-dominant and colonic CD.

Methods: We performed a single center, IRB-approved, retrospective review of all adult CD patients who received ustekinumab. We stratified patients by ileal involvement: ileum-dominant (ileal and ileocolonic) and colonic CD. We collected data on disease duration, disease behavior, prior biologic therapy, concomitant immunomodulator, CD-related surgeries and hospitalizations, serum c-reactive protein (CRP), and endoscopic presence of ulcers. The primary outcome was absence of ulcers on follow-up colonoscopy. The secondary outcomes included CRP, calprotectin, surgery, and hospitalization. Chi-square tests (or Fisher’s exact test) and two-sample t-tests (or Wilcoxon’s rank sum test) were used to compare categorical and numeric variables between groups, respectively; analyses were performed using R Computing Software versions 3.6.1.

Results: 84 patients with ileum-dominant CD and 27 patients with colonic CD were treated with ustekinumab. Baseline characteristics of the cohort are in Table 1. The median time to follow-up endoscopy was 13 months. Follow-up colonoscopy after ustekinumab therapy was ulcer-free in 45% of ileum-dominant CD and 76% of colonic CD (p=0.02). Of patients with ulcers on endoscopy prior to starting ustekinumab, 24% of ileum-dominant CD and 67% of colonic CD were ulcer-free (p=0.01) on follow-up colonoscopy. There were similar rates of hospitalizations and surgery and no significant differences in mean calprotectin and CRP between the two groups on follow-up after ustekinumab therapy.

Discussion: This updated real-world experience of ustekinumab demonstrates higher rates of endoscopic healing among colonic CD when compared to ileum-dominant CD. Disease location may predict endoscopic healing by ustekinumab in CD. Further studies are necessary to expand our understanding of different CD phenotypes and their responsiveness to ustekinumab.

	Ileum-Dominant CD (n=84)	Colonic CD (n=27)
Age at diagnosis, n, mean years +/- SD	84, 27.7 +/- 13.8	27, 37.6 +/- 17.0
Female gender, n, %	42, 50.0%	17, 63.0%
Tobacco use	16, 19.1%	2, 7.4%
Median Disease duration, years (25^th, 75^th)	10.8, (5.4, 20.1)	5.2, (2.1, 16.0)
Disease Behavior
B1, n, %	25, 29.8%	13, 48.2%
B2, B3, or B2/B3, n, %	59, 70.2%	14, 51.9%
Perianal Disease, n, %	20, 23.8%	11, 40.7%
Prior anti-TNF use, n, %	76, 90.5%	21, 77.8%
0, n, %	8, 9.5%	6, 22.2%
1, n, %	18, 23.7%	12, 57.1%
2, n, %	50, 65.8%	4, 19.1%
3, n, %	8, 10.5%	2, 9.5%
4, n, %	0, 0%	3, 14.3%
Prior anti-integrin use	18, 21.4%	10, 37.0%
History of prior Crohn’s related surgery, n, %	43, 51.2%	12, 44.4%
Concomitant therapy (steroids or thiopurine/MTX), n, %	34, 40.5%	9, 33.3%

Table: Table 1: Baseline Disease Characteristics of Patients with Ileum-Dominant and Colonic CD

Disclosures:

Elvis Arteaga indicated no relevant financial relationships.

Eric Mao: Pfizer – Advisory Committee/Board Member.

Sirisha Grandhe indicated no relevant financial relationships.

Nuen Tsang Yang indicated no relevant financial relationships.

Elvis Arteaga, MD¹, Eric J. Mao, MD¹, Sirisha Grandhe, MD², Nuen Tsang Yang, MS³. C0356 - Real World Ustekinumab Experience in Ileum-Dominant versus Colonic Crohn’s Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.