Article Dans Une Revue Therapeutic Advances in Gastroenterology Année : 2025

Real-world comparison of effectiveness between ustekinumab and a second-line anti-TNF agent in patients with symptomatic stricturing Crohn’s disease failing to respond to a first-line anti-TNF agent: the USTEKNOSIS study

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Background: Anti-tumor necrosis factor (TNF) agents are now accepted as the first-line medical treatment for stricturing Crohn’s disease (CD). However, data are lacking about the effectiveness of advanced therapies after anti-TNF failure. Objectives: To compare the effectiveness of ustekinumab and a second-line anti-TNF agent after failing to respond to a first-line anti-TNF for a symptomatic stricturing CD. Design: Multicenter retrospective study. Methods: We included consecutive adult patients with CD treated with ustekinumab or anti-TNF for symptomatic stricture (confirmed on imaging or endoscopy) after prior failure of one anti-TNF for the current stricture. Short-term endpoints were symptomatic remission (composite endpoint) at 6 months, defined as no abdominal pain, no vomiting, no food restriction, no sub-occlusive episode, no steroid, no surgery, and no drug discontinuation or symptomatic response (same definition except for tolerating mild abdominal pain). Long-term endpoints were time to drug discontinuation for treatment failure and to bowel damage progression. The comparisons were performed after using propensity score analysis. Results: Seventy patients were included (34 on ustekinumab, 36 on anti-TNF). After propensity score adjustment, symptomatic remission at 6 months was achieved in 73.9% of patients receiving ustekinumab compared to 42.7% in the anti-TNF group ( p = 0.24), while symptomatic response was observed in 84.0% and 49.5%, respectively ( p = 0.13). Predictors of remission in the ustekinumab group were prior bowel resection ( p = 0.001) and stricture length <12 cm ( p = 0.042). The risk of treatment discontinuation (hazard ratio (HR) = 2.86 (1.33–6.15); p = 0.008) and bowel damage progression (HR = 3.90 (1.64–9.24); p = 0.003) were higher in the anti-TNF group. Conclusion: Ustekinumab appears more effective than a second-line anti-TNF in patients with symptomatic stricturing CD after failing to respond to a first-line anti-TNF.

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hal-05354227 , version 1 (26-01-2026)

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Guillaume Le Cosquer, Bruno Pereira, Arthur Jammet, Mathurin Fumery, Anthony Buisson. Real-world comparison of effectiveness between ustekinumab and a second-line anti-TNF agent in patients with symptomatic stricturing Crohn’s disease failing to respond to a first-line anti-TNF agent: the USTEKNOSIS study. Therapeutic Advances in Gastroenterology, 2025, 18, ⟨10.1177/17562848251389476⟩. ⟨hal-05354227⟩
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