Katie Falloon, MD: SEQUENCE and Treatment Positioning

During a period of rapid growth and development in the inflammatory bowel disease (IBD) treatment landscape, understanding treatment positioning is of paramount importance to aid the optimal use of these therapies in clinical practice.

The phase 3b SEQUENCE study, spotlighted in the fourth issue of Qazi Corner, was particularly useful for advancing treatment positioning in Crohn disease (CD) because it directly compared the efficacy and safety of ustekinumab and risankizumab.

In an article providing an overview of the study’s design, its results, and their clinical implications, Katie Falloon, MD, described the importance of SEQUENCE and what its findings contribute to our current understanding of positioning risankizumab versus ustekinumab.

In an interview with HCPLive, Falloon described the various medications available for IBD with different mechanisms of action, safety profiles, and modes of delivery. Although she noted this was a good thing for both patients and providers, she also pointed out uncertainty regarding the positioning of these therapies: “With more choice comes more questions about how we should be positioning these therapies, and a lot of the data that we have to answer that question is indirect.”

Falloon also called attention to the quality of the data produced by SEQUENCE, highlighting risankizumab’s superiority to ustekinumab for endoscopic remission at week 48 in a cohort of patients diagnosed with moderate to severe CD refractory to ≥1anti-tumor necrosis factor (TNF) medication.

Although both treatments act by blocking cytokine signaling important for CD pathogenesis, differences in selectivity impact their efficacy. Ustekinumab, the first available medication of this class, blocks the cytokines interleukin-12 (IL-12) and IL-23, whereas risankizumab selectively blocks only IL-23.

“I think positioning of almost any other agent would be interesting to know and helpful for IBD patients,” Falloon said.

Read Falloon’s original article from the fourth issue of Qazi Corner here