Use of real-world data to assess the effectiveness of ustekinumab in treating IBD patients: a retrospective linked database study in northwest London.

Background: Data on the optimum positioning of biologics in the treatment of inflammatory bowel disease (IBD) are limited.
Research Design and Methods: This was a longitudinal retrospective study of linked health-care data from northwest London, UK, for adults who started ustekinumab for IBD from 1 April 20161 April 2016 to 1 April 20211 April 2021. We compared outcomes by line of therapy (1 vs. 2 or 3+) and age group (18‒59 years or ≥ 60 years). In an analysis of CD patients, we calculated risks of IBD-related hospitalization, IBD-related abdominal surgery, ustekinumab persistence, and switching by line of therapy.
Results: Of 163 patients screened, 149 were eligible. Age had no effect on outcomes. Elective all-cause hospital admissions were significantly higher when ustekinumab was used as second-line or third-line therapy compared with first-line treatment ( p  = 0.0048 and p  = 0.001, respectively). In CD patients the numbers of hospital admissions were also higher with second-line or third-line therapy ( p  = 0.040 and p  = 0.018, respectively). Use of ustekinumab as third-line therapy significantly increased the risk of IBD-related hospitalization (hazard ratio 2.5, 95% CI 1.1‒5.6, p  = 0.029), IBD-related abdominal surgery (9.45, 1.2‒75.7, p  = 0.03), and switching (14.6, 1.6‒131.0, p  = 0.02). Drug persistence risks did not differ.
Conclusions: These findings support the use of ustekinumab as first-line therapy.