S1514 Comparison of Ustekinumab and Vedolizumab Effectiveness in Perianal Crohn’s Disease: A Matched-Cohort Study

Introduction: Perianal Crohn’s disease (CD) is a severe and disabling phenotype of CD, frequently needing multidisciplinary medical and surgical care. This study aimed to compare the clinical effectiveness of ustekinumab vs vedolizumab in patients with perianal CD using a real-world database. Methods: We conducted a retrospective cohort study using the TriNetX database, to examine adults (≥18 years) with perianal CD (2016-2023). Patients were divided into 2 cohorts depending on current therapy: ustekinumab vs vedolizumab. After propensity score matching (PSM), 770 patients remained in each group. Outcomes were assessed over 1, and 2-years following treatment initiation. Primary outcomes included the use of oral and IV corticosteroids, antibiotics (metronidazole, ciprofloxacin, or augmentin), abdominal and anal surgeries. Secondary outcomes included hospitalization and emergency department (ED) visits. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated. Results: After PSM, 770 patients were included in each group, with well-balanced baseline characteristics and prior biologic use. At 1 year, patients treated with ustekinumab were significantly less likely to receive oral steroids (aOR 0.62; 95% CI: 0.51–0.77; P < 0.001), IV steroids (aOR 0.60; 95% CI: 0.49–0.74; P < 0.001), or antibiotics (aOR 0.88; 95% CI: 0.79–0.99; P = 0.03) compared to those on vedolizumab. Additionally, they had lower odds of hospitalization, emergency department visits, ileostomy/colostomy, and colectomy/enterectomy. Anal surgery rates were similar between groups. At 2 years, ustekinumab was consistently associated with reduced use of oral steroids (aOR 0.72; 95% CI: 0.59–0.89; P = 0.002), IV steroids (aOR 0.59; 95% CI: 0.48–0.72; P < 0.001), hospitalization (aOR 0.51; 95% CI: 0.41–0.63; P < 0.001), and emergency department visits (aOR 0.64; 95% CI: 0.51–0.80; P < 0.001). No significant differences were observed in antibiotic use, ileostomy/colostomy, colectomy/enterectomy, or anal surgeries. Conclusion: Ustekinumab was associated with significantly lower rates of steroids use, antibiotics, abdominal surgeries and hospitalizations compared to vedolizumab over 1 year in patients with perianal CD. However, there was no significant difference in antibiotics and surgeries in 2 years. These findings suggest ustekinumab has superior clinical effectiveness in managing this challenging complicated phenotype.