Ustekinumab for ileal stricturing Crohn's disease-an international multicenter retrospective cohort study.

Sara El Ouali, Mark E Baker, Cathy Lu, Alexandra Medellin, David H Bruining, Joel G Fletcher, Aki Inoue, Miguel Regueiro, Ronald K Ottichilo, Shayla Schoenoff, Ryan Rosentreter, James Bena, Taha Qazi, Joseph Sleiman, Stefan D Holubar, Samantha Gauriloff, Namita S Gandhi, Benjamin L Cohen, Idan Goren, Numan Balci, Florian Rieder

Journal: Journal of Crohn's & colitis 2026;20(3):

PMID: 41934342

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Abstract

BACKGROUND & AIMS

Stricturing Crohn's disease (CD) is a significant problem, and no selective anti-fibrotic therapies are available. Anti-inflammatory approaches are the mainstay of medical treatment. However, data on the efficacy of ustekinumab (USTE) in ileal stricturing CD are lacking. Our aim was to assess its efficacy in this setting.

METHODS

We performed an international multicenter observational cohort study evaluating adult CD patients who received USTE within 6 months of imaging-confirmed symptomatic stricturing small bowel disease. Outcomes were rates of endoscopic balloon dilation (EBD), surgery, intervention (defined as the composite need for EBD or surgery), recurrent obstructive symptoms, and USTE persistence.

RESULTS

Fifty-seven patients were included (51% female, median age 43 years). Median follow-up was 17 months. Intervention rates were 35%, 45%, and 69% of patients, at 12, 24, and 48 months, respectively. USTE persistence was 78%, 76%, and 52% at 12, 24, and 48 months. Estimated obstructive symptoms rates were 31% and 49% at 12 and 24 months, respectively. EBD within 6 months prior to starting USTE was associated with an increased risk of intervention. Increased bowel wall thickness on imaging, prior biologic use, and obstructive symptom duration were associated with USTE discontinuation. Occurrence of obstructive symptoms during treatment was associated with prior biologic use, EBD within 6 months of starting USTE, and a lower BMI.

CONCLUSIONS

USTE appears to be an appropriate medical option in biologic-experienced CD patients with ileal strictures. Further prospective data are needed to better define outcomes and predictors of response in this setting.

© The Author(s) 2026. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

Address: Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.; Imaging Institute, Cleveland Clinic, Cleveland, OH, United States.; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.; Department of Radiology, University of Calgary, Calgary, AB, Canada.; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.; Department of Radiology, Mayo Clinic, Rochester, MN, United States.; Department of Radiology, Shiga University of Medical Science, Shiga, Japan.; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.; Department of Inflammation and Immunity, Cleveland Clinic Research, Cleveland Clinic Foundation, Cleveland, OH, United States.; Department of Quantitative Health Sciences, Cleveland Clinic Research, Cleveland Clinic, Cleveland, OH, United States.; Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.; Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.; Cleveland Clinic Program for Global Translational Inflammatory Bowel Diseases, Cleveland, OH, United States.; Imaging Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.; Department of Inflammation and Immunity, Cleveland Clinic Research, Cleveland Clinic Foundation, Cleveland, OH, United States.; Cleveland Clinic Program for Global Translational Inflammatory Bowel Diseases, Cleveland, OH, United States.

DOI: 10.1093/ecco-jcc/jjag038

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https://medlineplus.gov/crohnsdisease.html

MeSH Terms: Humans, Crohn Disease, Female, Ustekinumab, Adult, Male, Retrospective Studies, Middle Aged, Intestinal Obstruction, Treatment Outcome, Constriction, Pathologic, Ileum