Colon to Rectum
Clin Gastroenterol Hepatol. 2023;21(13):3387–96.e1
Delayed ustekinumab responders in ulcerative colitis have greater inflammatory burden but similar outcomes as early responders
Background and aims: Differences in 1-year outcomes among early compared with delayed responders to vedolizumab have been shown in ulcerative colitis. However, it is unclear whether similar differences exist with ustekinumab, and what factors differentiate delayed responders from non-responders.
Methods: This study was a post-hoc analysis of patient-level data from the UNIFI clinical trial. Ustekinumab-treated patients with clinical response, defined as a reduction in total Mayo score of ≥ 30% and ≥ 3 points from baseline with a reduction in their rectal bleeding subscore of ≥ 1 or a rectal bleeding subscore of ≤ 1, at week 8 were deemed early responders and their outcomes were compared with delayed responders (week-8 non-responders who subsequently responded at week 16). The primary outcome assessed was 1-year clinical remission, defined as a total Mayo score of ≤ 2 and no subscore > 1.
Results: The authors included 642 ustekinumab-treated patients, including 321 (50%) early responders, 115 (17.9%) delayed responders, and 205 (32.1%) non-responders. No differences were observed for 1-year clinical remission among early versus delayed responders (132/321 [41.1%] vs. 40/115 [34.8%]; p = 0.233), or for other outcomes assessed regardless of induction dose. Compared with early responders, delayed responders had more severe baseline Mayo endoscopic disease (88/115 [76.5%] vs. 206/321 [64.2%]; p = 0.015) and abnormal baseline C-reactive protein level > 3 mg/l (83/115 [72.2%] vs. 183/321 [57%]; p = 0.004). Compared with non-responders, delayed responders had a significant decrease in C-reactive protein level (F-value [degrees of freedom, mean squares] [4, 844]; p < 0.0001) and fecal calprotectin level (F[4, 818]; p < 0.0001) through week 16.
Conclusions: Compared with early ustekinumab responders, delayed responders had a greater inflammatory burden at baseline. Early and delayed responders had similar 1-year outcomes. Biomarker decline observed in delayed responders can help differentiate them from non-responders.