Outcomes of Risankizumab in Patients with Crohn's Disease and Prior Ustekinumab Exposure in a Multicenter Academic...

Risankizumab (RZB) and ustekinumab (UST) are interleukin inhibitors that are used for the treatment of moderate-to-severe Crohn's disease (CD). Data on outcomes of RZB in patients previously treated with UST are limited. We aim to evaluate the efficacy of RZB in patients previously exposed to UST.

This retrospective study included adult patients with CD who were prescribed RZB and had prior UST exposure at a multicenter academic institution between 1/2022 and 8/2024. We extracted demographic, CD-related, and medication-related data, as well as subjective and objective endpoints while on UST and RZB. Fisher's exact test and the Wilcoxon rank-sum test were used in the analysis.

Among 68 patients treated with RZB and prior UST therapy, 43 (63.2%) experienced symptomatic improvement on RZB, 57 (83.8%) avoided surgery, and 12 of 25 patients on steroids (48%) achieved steroid-free remission. Average C-reactive protein, fecal calprotectin, and endoscopic scores decreased on RZB compared with UST. A higher number of previous CD medications was associated with a lack of improvement on RZB (p = 0.011). Secondary nonresponse to UST was significantly associated with improvement on RZB (p = 0.047). No difference in RZB response was observed between patients maintained on standard UST dosing and those who underwent dose escalation (p = 0.557).

RZB appears to be an effective treatment option for patients with CD and prior UST use, particularly those with secondary loss of response. A higher number of previously trialed therapies was associated with reduced likelihood of response, underscoring the importance of early, strategic treatment sequencing.