Clinical outcomes following switch from risankizumab to guselkumab in Crohn's disease: a real-world case series

Risankizumab is an interleukin (IL)-23 inhibitor that is effective for the treatment of moderate-to-severe Crohn's disease (CD). However, many patients experience loss of response. Switching within the IL-23 inhibitor class to agents with more frequent dosing, such as guselkumab, may represent a salvage strategy, though no supporting data exist. We aimed to describe outcomes following switching between IL-23 antagonists.

This case series included five CD patients at a Canadian tertiary care center with primary non-response or secondary loss of response to risankizumab who were switched to guselkumab. Data were collected at baseline, during risankizumab therapy, and after switching.

Five CD patients with inadequate response to risankizumab were included. One patient (20%) had primary non-response and four (80%) had secondary loss of response. Risankizumab duration ranged from 3 to 38 months (mean 17.4 ± 12.9). Four patients had active disease on baseline endoscopy before switching. Mean follow-up after switching was 3.8 ± 1.9 months. Mean CD-PRO2 improved from 22.7 to 5.2 post-switching. Clinical response (≥50% CD-PRO2 reduction) was achieved in 4/5 patients (80%), and clinical remission (CD-PRO2 < 8) was similarly achieved in 4/5 patients (80%). Among four patients with biochemical data, biochemical response (≥50% reduction in fecal calprotectin [FCal]) and remission (normalization of FCal) each occurred in 75%, with a mean FCal reduction of 618 µg/g. One patient had biochemical worsening despite clinical improvement. No safety concerns were reported.

In CD patients with loss of response to risankizumab, switching to guselkumab may be effective in selected patients. Larger confirmatory studies are needed.