Perspective from Stephen B. Hanauer, MD
May 28, 2019
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Stelara effective for induction, maintenance of UC regardless of biologic history

Perspective from Stephen B. Hanauer, MD
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SAN DIEGO — Stelara was effective for the induction and maintenance treatment of patients with moderate-to-severe ulcerative colitis whether or not they previously failed biologic therapy, according to data from the UNIFI study presented at Digestive Disease Week.

“Ustekinumab [Stelara, Janssen] is an IL-12/23 blocker that’s approved for Crohn’s disease, and ... is also effective in induction and maintenance of clinical remission in patients with moderate-to-severe ulcerative colitis,” Bruce E. Sands, MD, of Icahn School of Medicine at Mount Sinai, said in his presentation. “But here we are looking at two distinct populations who came into this study.”

In the UNIFI trial, researchers randomly assigned patients to a baseline intravenous induction dose of ustekinumab (130 mg or weight-range doses of about 6 mg/kg) or placebo. Responders entered into maintenance therapy and received either 90 mg of ustekinumab (every 12 weeks or every 8 weeks) or placebo.

The trial included an analysis of the drug’s efficacy in patients who previously failed biologic treatment (51.1% of randomized patients), of which 98% had failed at least one anti-TNF, and 32.6% failed both anti-TNF and Entyvio (vedolizumab, Takeda).

During the induction phase of the trial, both doses of ustekinumab were superior to placebo regarding clinical remission in patients who were either biologic failures (BF; P < .001 for both doses) or non-biologic failures (NBF; P < .05 for both doses).

In the maintenance phase in both BF and NBF patients, the proportion of patients who achieved clinical remission was greater for both the every 8 weeks and every 12 weeks ustekinumab groups compared with placebo (BF P < .001, P = .044, respectively; NBF P = .024, P = .020).

Additionally, a greater proportion of NBF and BF patients in the ustekinumab every 8 weeks and every 12 weeks groups achieved each secondary endpoint of maintenance (clinical response, endoscopic healing, corticosteroid-free remission and clinical remission in baseline remitters) compared with the placebo groups.

“Ustekinumab was effective for induction and maintenance treatment of moderately-to-severely active UC as assessed by clinical response, clinical remission, endoscopic healing and steroid-free remission,” Sands concluded. “This effectiveness was also observed in patients with a history of biologic therapy failure which included both TNF antagonists, and as well as patients who had experienced and failed both anti-TNF and vedolizumab and patients without a history of biologic therapy failure.” – by Alex Young

Reference:

Sands BE, et al. Abstract 833. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Sands reports financial support for research from AbbVie, Allergan, Arena, Boeringher-Ingelheim, Celgene, Ferring, Gilead, Janssen, Lilly, Otsuka, Pfizer, Protagonist, Rheos Medicines, Synergy, Takeda, Theravance Biopharma R&D and TiGenix. Please see the study abstract for all other authors’ relevant financial disclosures.