P0939 Efficacy of Ustekinumab-based integrated medicine therapy in patients with symptomatic stricturing Crohn’s disease: a retrospective study
Authors: Liu J , Hu W , Li S , Hu S , Chen Y 
Published: January 2025

Abstract

Background
Strictures are the most prevalent structural complication in Crohn’s disease (CD). Surgery and endoscopic balloon dilation are widely used worldwide. there is a lack of data regarding the use of ustekinumab (UST) for symptomatic stricturing CD in China. This study aims to assess the efficacy of UST in these patients and identify factors predicting treatment success.

Methods
This observational cohort study retrospectively included adult CD patients undergoing their first UST therapy for symptomatic strictures, confirmed via endoscopy or imaging. We defined the primary outcome as UST continuation without the prohibited treatments (corticosteroids, other biologics), endoscopic dilation, or bowel resection at week 52. Treatment effectiveness was evaluated according to the relief of symptoms, and baseline factors independently associated with success were identified using a logistic regression model.

Results
From June 2022 to April 2024, 73 patients were screened, of whom 54 were included in the study. Treatment success was observed in 44 out of 54 patients (81.5%) at week 52, while 10 patients required surgery or other biologics during follow-up. Regarding endoscopic stenosis remission, 11 (39%) patients could pass the colonoscope across the previously obstructed area, and the DBE-CD decreased from 3.85±0.15 to 3.04±0.24 (p=0.048). Complete resolution of prestenotic dilatations (&lt;3.0 cm) on CT enterography was seen in 20 of 38 patients (53%). Intestinal ultrasound at 52 weeks showed an improvement (&gt;25%) in bowel wall thickness in 23 (43%) of the 54 patients. UST reduced the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) from 71.71±5.23 to 54.73±5.41 (p=0.036). Faecal calprotectin levels normalized in 23 (43%) patients (p=0.01), while normalization of CRP was seen in 37 (69%) patients (p=0.25). Aside from one patient (2%) reporting leukemia and two patients (4%) reporting serious infections, no other severe adverse events were observed during the study.

Conclusion
Ustekinumab (UST) is effective in controlling the progression of intestinal strictures in Crohn’s disease (CD) patients. The majority of patients experienced symptom remission, improved stricture morphology, and a reduction in stricture-associated inflammation.

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