The following article is a part of conference coverage from the 2019 Advances in Inflammatory Bowel Diseases (AIBD) Meeting, being held in Orlando, Florida. The team at MPR will be reporting on the latest news and research conducted by leading experts gastroenterology. Check back for more from the 2019 AIBD Meeting.


ORLANDO – Prescribing patterns among patients treated with ustekinumab for Crohn disease (CD) were presented at the 2019 Advances in Inflammatory Bowel Diseases (AIBD) Annual Meeting, held December 12-14, 2019 in Orlando, FL. 

A retrospective chart review was conducted in 109 adult patients who initiated ustekinumab for the treatment of CD from seven independent GI practices in the U.S. The authors’ primary objectives were to characterize patients who initiated ustekinumab therapy, to assess early changes in outcomes, and to provide insight into treatment decision-making for initiation in real-world clinical practice.

Prior to initiating ustekinumab for CD, the authors found that 18% of patients were biologic-naive while 82% of patients were biologic-experienced, with 54.9% of those patients have attempted ≥2 biologics. The most common biologics attempted prior to switching to ustekinumab were adalimumab (49.1%), vedolizumab (21.1%), infliximab (17.5%), and certolizumab (12.3%). 

In the pre-index (6 months before initiation) and post-index (6 months after initiation) periods, 44% of patients lacked documentation for laboratory results and reference to testing. Statistically significant differences were seen among patients in the pre-index and post-index periods for reported hospitalizations (14% vs 5%, respectively) and corticosteroid use (15% vs 6%, respectively). Additionally, over 90% of patients remained on ustekinumab for at least 6 months after initiation.

Secondary loss of response, followed by primary non-response of previous biologic therapy, were the most frequently documented reasons for switching to ustekinumab therapy in biologic-experienced patients. In biologic-naive patients, the primary reason for initiating ustekinumab was non-response to previous non-biologic therapy (eg, 6-mercaptopurine, prednisone) and physician recommendation based on symptoms. Other factors for  decision-making include family history of adverse events with biologics and pre-existing comorbidities that increases infection risk.

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Ustekinumab is an interleukin-12 and interleukin-23 antagonist indicated for the treatment of moderately to severely active Crohn disease or ulcerative colitis. Other indications include active psoriatic arthritis, alone or in combination with methotrexate, and moderate to severe plaque psoriasis in patients who are candidates for phototherapy or systemic therapy.

Reference:

Ruetsch C, Davis T, Clerie J, et al. Patterns of Care Among Patients Treated with Ustekinumab for Crohn’s Disease: Results from a Chart Review. Presented at the 2019 AIBD Annual Meeting on December 12-14 in Orlando, FL.