David P. Hudesman, MD, discusses clinical implications from ACG 2022 data on ustekinumab therapy for the management of ulcerative colitis and shares advice for managing patients with the disease.
David P. Hudesman, MD: I think for our patients when we are talking about choosing a therapy, since we have multiple options, we want to talk about therapies that put them into response and remission early but also have that sustained response. Durability is key, but safety is also a big factor. We know this IL-12/23 class is a very safe class. We know that from our real-world evidence as well as some data from the psoriasis registries. But when we are talking about safety, concomitant medications are a big thing. If a patient is on ustekinumab as well as multiple courses of prednisone, that safety signal or that safety benefit really goes away. To see that this medication cannot only keep patients well long term, but also can keep them off of steroids, really drives home the safety component.
In managing patients with moderate to severe ulcerative colitis, the most important thing is to define the extent and severity of disease and isolate those patients who are moderate to severe and start therapy early. I think if you start therapy early, it doesn’t matter as much which biologic agent or small-molecule agent you use. But if you started early, you are going to see high remission and high response rates short term. The other part of this is once they are doing well and they are feeling well, we don’t want to lose them. We want to have some type of maintenance plan such as having them come in every 3 to 6 months for visits and checking biomarkers like CRP [C-reactive protein] and fecal calprotectin to make sure they are staying well. Also, using colonoscopy down the road. When choosing therapy, not only think about what’s happening in the short term, which is extremely important, but about how they can remain well long term due to the durability of the agent.
Transcript Edited for Clarity