Intest Res.  2024 Jul;22(3):351-356. 10.5217/ir.2023.00091.

Ustekinumab for anti-tumor necrosis factor refractory pediatric ulcerative colitis: a promising approach towards endoscopic healing

• Rehman R
• Riaz MS
• Esharif D
• Has P
• Herzlinger M
• Shapiro J
• Subedi S

• KMID: 2558194
• DOI: http://doi.org/10.5217/ir.2023.00091

Abstract

Background/Aims
To describe the role of ustekinumab in inducing remission and endoscopic healing in anti-tumor necrosis factor α nonresponsive pediatric ulcerative colitis patients at a tertiary care inflammatory bowel disease center.
Methods
A retrospective chart review was performed on patients with ulcerative colitis receiving ustekinumab. Primary outcome was steroidfree clinical remission at follow-up. Secondary outcomes were biochemical remission and endoscopic healing.
Results
Ten children were analyzed; 7 (70%) had ulcerative colitis, and 3 (30%) had inflammatory bowel disease unspecified with colitis. Median follow-up period was 56 weeks. Nine patients (90%) achieved steroid-free clinical remission and biochemical remission. Seven patients had follow-up colonoscopies, out of which 6 (86%) achieved endoscopic remission, while 1 (14%) underwent colectomy. Out of the 3 patients without a follow-up colonoscopy, fecal calprotectin levels downtrended to < 150 mg/kg in 2 patients and < 400 mg/kg in 1 patient from baseline level of > 2,000 mg/kg.
Conclusions
Ustekinumab appears efficacious in achieving not only clinical and biochemical remission but also has promising role in inducing endoscopic healing end point in patients who fail other biologics.

Keyword

Pediatrics; Inflammatory bowel disease; Ulcerative colitis; Biologics

Figure

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  Fig. 1. Percentage of patients who achieved remission.

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  Fig. 2. (A) Individual patient C-reactive protein levels by visit (mg/L). (B) Individual patient fecal calprotectin levels by visit (mg/kg). ID refers to patient identification number. Dx, diagnosis; Ind, induction.

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  Fig. 3. Individual patient Pediatric Ulcerative Colitis Activity Index (PUCAI) scores by visit. ID refers to patient identification number. Dx, diagnosis; Ind, induction.

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