Abstract

Efficacy of Ustekinumab and Vedolizumab Among Postoperative Crohn's Disease Patients as Postoperative Prophylaxis and Rescue Therapy: Real-world Data

Inflamm Bowel Dis. 2024 Jul 2:izae137. doi: 10.1093/ibd/izae137. Online ahead of print.

 

Furkan U Ertem 1 2Claudia Ramos Rivers 1Amir Ali Ghaffari 1Andrew R Watson 3Gong Tang 4Marc Schwartz 1Elyse Johnston 1Arthur Barrie 4Janet Harrison 4Jeffrey M Dueker 1Doug Hartman 1David G Binion 1

 
     

Author information

1Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.

2Medical Group of Carolinas, Gastroenterology, Spartanburg Regional Health System, Spartanburg, SC, USA.

3Division of Colorectal Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

4University of Pittsburgh, Pittsburgh, PA, USA.

Abstract

Background: Almost half of patients with Crohn's disease (CD) require bowel surgeries in their lifetime. Due to the high risk of postoperative disease recurrence and high rate of previous antitumor necrosis factor (anti-TNF) failure, often alternative therapy options such as ustekinumab (UST) and vedolizumab (VDZ) are used. We aimed to evaluate the efficacy of UST and VDZ among postoperative CD patients as postoperative prophylaxis and rescue therapy.

Methods: Consented CD patients who underwent initial ileocecal resection and were treated with UST and VDZ were included in this study. Demographics, clinical characteristics, health care utilization, endoscopy scores, and surgery outcomes were collected. Postoperative early CD recurrence was defined as a Rutgeerts endoscopic score ≥i2 within the first 2 years. The rescue therapy group was defined as patients who received either UST or VDZ after having Rutgeerts endoscopic score ≥i2 postoperatively.

Results: During 2009 to 2019, 98 CD patients were treated with UST or VDZ postoperatively. Postoperative early recurrence rates were 5% (n = 1 out of 20) and 6% (1 out of 15) for the UST and VDZ groups, respectively. Two patients from the UST group and 1 patient from the VDZ group required bowel surgery during follow-up with median drug exposure of 51 (95% confidence interval [CI], 29-61) and 30 (95% CI, 14-63) months, respectively; 55% and 69% of patients had at least 1 point of improvement on postoperative endoscopic Rutgeerts score, respectively, for UST and VDZ. Only 3 out of 40 and 1 out of 23 patients required bowel surgery during follow-up while receiving UST and VDZ as rescue therapy.

Conclusions: Both UST and VDZ were effective as postoperative therapies either as prophylaxis or rescue therapy.

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