Ustekinumab is a promising option for the treatment of postoperative recurrence of Crohn's disease
Fabio Salvatore Macaluso, Mauro Grova, Filippo Mocciaro, Roberto Di Mitri, Antonino Carlo Privitera, Maria Emanuela Distefano, Alessandro Vitello, S. Camilleri, Concetta Ferracane, Dario Pluchino, Nunzio Belluardo, Emiliano Giangreco, Walter Fries, Anna Viola, Maria Cappello, Livia D'Amato, Carmelo Bertolami, Marco Ventimiglia, Sara Renna, Angelo Casà, E D'Antonio, Simona De Vivo, Ambrogio Orlando, Sicilian Network for Inflammatory Bowel Disease (SN‐IBD)
Abstract
BACKGROUND AND AIM: Postoperative recurrence (POR) following ileocolonic resection is a major concern in patients with Crohn's disease (CD). The role of ustekinumab (UST) in this setting is poorly known. METHODS: All consecutive CD patients with a baseline colonoscopy at 6-12 months from ileocolonic resection showing POR (Rutgeerts score ≥ i2) who were treated with UST after the baseline colonoscopy and with an available post-treatment endoscopy, were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). The primary outcome was endoscopic success, defined as reduction of at least one point of Rutgeerts score. The secondary outcome was clinical success, assessed at the end of follow-up. Reasons for clinical failure included mild clinical relapse (Harvey-Bradshaw index 5-7), clinically relevant relapse (Harvey-Bradshaw index > 7), and need for new resection. RESULTS: Forty-four patients were included (mean follow-up: 17.8 ± 8.4 months). The baseline postoperative colonoscopy showed severe POR (Rutgeerts score i3 or i4) in 75.0% of patients. The post-treatment colonoscopy was performed after a mean of 14.5 ± 5.5 months following initiation of UST. Endoscopic success was reported in 22 out of 44 (50.0%) patients, of whom 12 (27.3%) achieved a Rutgeerts score i0 or i1. Clinical success at the end of follow-up was reported in 32 out of 44 patients (72.7%); none of the 12 patients with clinical failure had achieved endoscopic success at post-treatment colonoscopy. CONCLUSIONS: Ustekinumab could be a promising option for the treatment of POR of CD.