A Retrospective Comparison of Postoperative Tumor Necrosis Factor-α Inhibitor Continuation versus Ustekinumab Switch in Crohn's Disease: Reset or Switch?

Abstract

Introduction: Ustekinumab (UST) is increasingly used in Crohn's disease patients with prior tumor necrosis factor-α inhibitor (TNFi) failure. However, whether to switch to another biologic or continue TNFi therapy at the time of surgery remains an important unresolved clinical question.

Methods: Among patients who underwent intestinal resection during TNFi therapy at our hospital from January 2008 to February 2022, 39 patients continued TNFi after surgery (TNFi continuation group) and 15 patients switched to UST after surgery (UST switch group) were included. Clinical and endoscopic recurrence rates were compared over long-term follow-up.

Results: This retrospective cohort study showed that the cumulative 2-year clinical recurrence-free rate was 82.6% in the TNFi continuation group and 60.0% in the UST switch group, with no statistical difference in the cumulative clinical recurrence-free rate between the two groups (log-rank test; p = 0.863). The follow-up endoscopy showed that postoperative endoscopic recurrence (PER) was observed in 14 of 34 patients (38.2%) in the TNFi group and 8 of 14 patients (57.1%) in the UST switch group, with no statistical difference between the two groups (p = 0.3384). Absence of PER at follow-up correlated with better long-term clinical outcomes. A medical claims database analysis confirmed no significant difference in the cumulative clinical recurrence-free rate (p = 0.232) or subsequent intestinal surgery-free rate (p = 0.554) between the TNFi continuation group and the UST switch group.

Conclusion: In patients undergoing surgery during TNFi treatment, there was no statistically significant difference between postoperative UST switching and TNFi continuation.