Ustekinumab Shows Superior Persistence in CD Patients With Prior Biologic Use

Among patients with prior exposure to biologic agents for Crohn disease (CD), ustekinumab was associated with superior treatment persistence, which researchers used as a gauge of real-world effectiveness. The finding appeared in a study in the American Journal of Gastroenterology.

“Comparative effectiveness research provides data on the relative benefits and risks between treatments. In CD, however, there are few head-to-head studies comparing advanced therapies, and none with long-term follow-up,” wrote corresponding author Rupert W. Leong, MBBS, FRACP, MD, of Concord Repatriation General Hospital, Sydney, Australia, and study coauthors.

The study investigated the use of biologic agents in patients with CD using data from a pharmaceutical dispensing registry in Australia, where there is no mandated prescribing order for biologics and all patients are eligible for treatment. The study covered the years 2005 through 2019.

The 15-year period included 1446 patients with a total 2029 lines of therapy and 5618 patient-years of follow-up. Per line of therapy, 45.1% of patients used adalimumab, 35.6% used infliximab, 7.6% used vedolizumab, and 11.7% used ustekinumab, according to the study.

Researchers found no differences in treatment persistence between biologics in patients who were previously biologic naïve. However, when used after a first-line agent, ustekinumab had significantly better persistence than non-ustekinumab biologics, anti-tumor necrosis factor (TNF) alpha therapy, and vedolizumab, the study found.

Prior biologic agent exposure had no effect on ustekinumab persistence, researchers reported. Furthermore, after use of an anti-TNF agent, ustekinumab had persistence superior to an alternative anti-TNF agent as well as vedolizumab.

“Using a propensity score-matched analysis adjusted for age, immunomodulator use, and bio-exposed status, ustekinumab had superior persistence to anti-TNF (P = 0.01),” the authors wrote. “Multivariate predictors of worse persistence were the use of a non-ustekinumab biological agent (adjusted hazard ratio 2.10, P < 0.001) and bio-experienced status (adjusted hazard ratio 1.23, P < 0.001).”

Reference

Chetwood JD, Ko Y, Pudipeddi A, Kariyawasam V, Paramsothy S, Leong RW. Biological agents in the treatment of Crohn's disease: a propensity score-matched analysis from the prospective persistence Australian national IBD cohort (PANIC3) study. Am J Gastroenterol. 2024;119(8):1536-1544. doi:10.14309/ajg.0000000000002679