The Efficacy of Combination Therapy with Ustekinumab and Budesonide for Crohn’s Disease: A Randomized Controlled Trial

Abstract

<b><i>Introduction:</i></b> Limited data exist on the efficacy of combination therapy with ustekinumab and budesonide in patients with Crohn’s disease. Our objective was to compare the clinical outcomes of ustekinumab and budesonide combination therapy with those of ustekinumab monotherapy. <b><i>Methods:</i></b> In this phase 2 single-center, double-blind, randomized controlled trial, we assigned 19 patients with Crohn’s disease with a Crohn’s disease activity index (CDAI) equal to or greater than 220 and less than 450 in a 1:1 ratio to receive ustekinumab and budesonide or ustekinumab for 32 weeks. The primary endpoint was the clinical remission rate at 8 weeks. The secondary endpoints were the clinical remission rate at 32 weeks and mucosal healing rates at 8 and 32 weeks. <b><i>Results:</i></b> Of 19 patients, the mean age was 37.8 years, and 42.1% were women (CDAI ≥220 and <450). There was no difference between combination therapy and ustekinumab monotherapy in terms of clinical remission rates (50.0% vs. 30.0%, <i>p</i> = 0.39 at 8 weeks and 37.5% vs. 20.0%, <i>p</i> = 0.41) and mucosal healing rates (75.0% vs. 90.0%, <i>p</i> = 0.40 and 37.5% vs. 60.0%, <i>p</i> = 0.34 at 8 and 32 weeks, respectively). The most common adverse event was an exacerbation of Crohn’s. There were no differences in safety profiles between the two groups. <b><i>Conclusions:</i></b> Our study showed no difference between ustekinumab monotherapy and ustekinumab and budesonide combination therapy in terms of the induction and maintenance of remission (trial registration number: jRCTs021200013).