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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (2): 253-259. doi: 10.19723/j.issn.1671-167X.2024.02.008

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Clinical remission and transmural healing of ustekinumab in patients with Crohn's disease

Yun WU,Yalan XU,Guoyan ZHANG,Yuanyuan ZHANG,Junyao WANG,Peng YOU,Tao PENG,Yulan LIU,Ning CHEN*()   

  1. Department of Gastroenterology, Peking University People's Hospital, Beijing 100044, China
  • Received:2023-06-19 Online:2024-04-18 Published:2024-04-10
  • Contact: Ning CHEN E-mail:chenning79@139.com
  • Supported by:
    the National Natural Science Foundation of China(82070566);the National Natural Science Foundation of China(81870387);Capital's Funds for Health Improvement and Research(2020-2Z-40813);Peking University People's Hospital Research and Development Foundation(RDJP2022-52);Peking University People's Hospital Research and Development Foundation(RDGS2002-09)

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Abstract:

Objective: To treat the Crohn's disease (CD) patients with ustekinumab (UST), to eva-luate their clinical and endoscopic remission, and to evaluate their transmural response (TR) and transmural healing (TH) condition using intestinal ultrasonography (IUS). Methods: Retrospective analysis was made on patients diagnosed with CD in Peking University People's Hospital from January 2020 to August 2022, who were treated with UST for remission induction and maintenance therapy. All the patients were evaluated on both week 8 and week 16/20 after treatment, including clinical, biochemical indicators, colonoscopy and IUS examination. Results: A total of 13 patients were enrolled in this study, including 11 males and 2 females. The minimum age was 23 years, the maximum age was 73 years and the mean age was 36.92 years. All the patients were in the active stage of disease before treatment, and the average Best Crohn's disease activity index (Best CDAI) score was 270.12±105.55. In week 8, the Best CDAI score of the patients decreased from 270.12±105.55 to 133.16±48.66 (t=4.977, P < 0.001). Eight patients achieved clinical remission while 5 patients remained in the active stage. Nine patients underwent colonoscopy evaluation. The average simple endoscopic score for Crohn's disease (SES-CD) score decreased from 10.71±7.14 before treatment to 6.00±7.81(t=2.483, P=0.048) in week 16/20. Four patients achieved endoscopic remission while 5 patients did not. In week 8, 5 patients achieved TR, 2 patients achieved TH, the other 6 patients did not get TR or TH. In week 16/20, 6 patients achieved TR, 3 patients achieved TH while the other 4 patients did not get TR or TH. There was no significant statistical difference in the TR effect of UST between small intestine and colon lesions (Fisher test, P > 0.999). The rate of UST transmural response in the patients who had had previous biological agent therapy was lower than those with no previous biological agent therapy, but there was no significant statistical difference (Fisher test, P=0.491). Conclusion: After treatment of UST, the clinical and endoscopic conditions of the CD patients had been improved, and some patients could achieve clinical remission and endoscopic remission. UST had good TR and TH effects on CD. TR might appear in week 8, and the TR effect increased in week 16/20. There was no significant statistical difference in the TR effect between small intestine and colon lesions. TR effect of UST was better in the patients who had no previous biological agent therapy than those who had had other biological agents, but the result had no significant statistical difference.

Key words: Crohn's disease, Ustekinumab, Transmural response, Transmural healing

CLC Number: 

  • R574.1

Figure 1

TR and TH under IUS of Crohn's disease patient A, patient 1, before UST therapy, the BWT of the descending colon was 9 mm; B, patient 1, after 8 weeks of treatment with UST, the BWT of the descending colon was 5 mm, achieving TR; C, patient 2, before UST therapy, the thickest BWT of the umbilical intestinal wall was 10 mm; D, patient 2, after 8 weeks of treatment with UST, the BWT of the same part returned to 2 mm, stratification was normal, and TH was achieved. TR, transmural response; TH, transmural healing; IUS, intestinal ultrasonography; BWT, bowel-wall thickness; UST, ustekinumab."

Figure 2

Changes in Best CDAI, CRP, and ESR before and after UST treatment Week 0, before UST therapy; Week 8, 8 weeks after UST therapy; Week 16/20, 16/20 weeks after UST therapy. Best CDAI, Best Crohn's disease activity index; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; UST, ustekinumab."

Figure 3

Changes in SES-CD scores before and after the application of UST Week 0, before UST therapy; Week 16/20, 16/20 weeks after UST therapy. UST, ustekinumab; SES-CD, simple endoscopic score for Crohn's disease."

Figure 4

Changes in BWT and the proportions of TR and TH in patients before and after UST application Week 0, before UST therapy; Week 8, 8 weeks after UST therapy; Week 16/20, 16/20 weeks after UST therapy. BWT, bowel-wall thickness; TR, transmural response; TH, transmural healing; UST, ustekinumab."

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