Ustekinumab Effective Treating Extra-Intestinal Manifestations of Crohn's Disease

Aiya Aboubakr, MD

New data assessed the effectiveness of ustekiumab in treatment of extra-intestinal manifestations (EIM) in patients with Crohn’s disease.

Investigators, led by Aiya Aboubakr, MD, Weill Cornell Medicine, found an improvement or resolution of EIM in two-thirds of patients with Crohn's disease after ustekinumab treatment.

The data was presented at 2021 Digestive Disease Week (DDW) Virtual Meeting.

Study

Investigators collected data on patients with a Crohn's disease diagnosis and documentation of active or prior EIM at the time of ustekinumab induction.

They categorized EIM as rheumatologic (peripheral or axial arthritis/arthralgias, cutaneous (erythema nodosum, pyoderma, oral aphthae), or ocular (uveitis).

The team obtained demographic data and clinical characteristics of the patient group, including medication use and baseline disease activity.

Primary outcomes included complete resolution of active EIM. Secondary outcomes included improvement in active EIM, recurrence of inactive EIM, and relation of EIM response to clinical and endoscopic response.

The team defined change in EIM activity, including improvement, resolution, or worsening, based on clinical documentation of self-reported changes.

Aboubakr and colleagues used descriptive statistics to summarize patient-level data, with Fisher’s tests to assess the associations between clinical characteristics and EIM response.

Results

Investigators found a total of 51 of 170 patients with Crohn's disease treated with UST had 73 documented pre-existing EIM to include in analysis.

Data show EIM was most commonly rheumatologic (n = 48, 65.8%), with dermatologic (n = 18, 24.6%) and ocular (n = 7, 9.6%) following.

The team found that rheumatologic EIMs involved axial joints alone (neck, hip, back, n = 4, 8.3%), peripheral joints (other than neck, hip, back, n = 31, 64%), or both (n = 9, 18.8%).

At the time of induction, 50 (68.5%) EIMs were active. Of this number, 16 (32.7%) were resolved, 18 (36.7%) improved, 14 (26.5%) had no change, and 2 (4.1%) worsened after UST.

Further, 23 (31.5%) were inactive at the time of induction, with 19 (78.3%) remaining quiescent and 5 (21.7%) recurred while on UST.

Investigators found patients with EIM response had a similar proportion of endoscopic remission compared to those without an EIM response.

A trend toward higher clinical remission in patient with EIM response (44.4%) versus non-response group (14.3%) was noted (P = .08).

No major differences in EIM response were identified by investigators in patients with peripheral arthritis alone (64%), compared to those with both peripheral and axial arthritis (66%).

In multivariate analysis, the team found corticosteroid use was associated with lower EIM response (OR, 0.02 – 0.98, P = .047).

Conclusion

Investigators concluded ustekinumab therapy for Crohn's disease improved or resolved EIM in two-thirds of patients in the study.

“Further data are required to identify factors associated with EIM response to UST, and to assess response using validated EIM scoring indices,” investigators wrote.

The study, “Effectiveness of Ustekinumab for Management of Extraintestinal Manifestations of Crohn’s Disease,” was published online by DDW.