S1993 Effectiveness and Safety of Guselkumab vs Risankizumab in Ulcerative Colitis: A Real-World Comparative Outcomes Analysis

Introduction: Guselkumab and risankizumab are interleukin (IL)-23 inhibitors increasingly used in the management of moderate to severe ulcerative colitis (UC). This study was an attempt to characterized the comparative benefits and risks of guselkumab vs risankizumab in UC patients. Methods: We performed a retrospective cohort study using the TriNetX Global Collaborative Network database. Adults (≥16 years) with UC treated with guselkumab (n = 118) or risankizumab (n = 504) were identified. Patients with Crohn’s disease, psoriasis, or other autoimmune indications for IL-23 inhibitors were excluded. Outcomes were assessed over a 30 to 365-day post-treatment window. Analyses included risk comparisons and Kaplan–Meier survival analysis. Results: Guselkumab was associated with significantly lower 1-year corticosteroid use when compared to risankizumab (22.0% vs 34.5%; risk difference: -12.5%, 95% CI: -21.0 to -3.9; P = 0.009). Kaplan–Meier estimates demonstrated a trend toward improved steroid-free survival with guselkumab (55.9% vs 39.8%; P = 0.405). Rates of hospitalization or emergency department visits were similar between the 2 groups (8.5% vs 10.7%; P = 0.471). Advancement to other therapies, including anti-TNF, JAK inhibitors, or vedolizumab, occurred in 8.5% of the GUS group vs 7.3% of the risankizumab group (P = 0.675). One of the limitations was that in this database, outcome counts fewer than 10 are rounded up to 10 to protect patient privacy. As a result, outcome rates below or equal to 8.5% may be overestimated, particularly in smaller cohorts. Conclusion: In this real-world analysis of patients with UC, guselkumab was associated with lower corticosteroid use when compared to risankizumab. Rates of hospitalization and therapy escalation were comparable between the 2 treatment groups. These findings suggest that Guselkumab may be a viable treatment option pending further validation in matched or prospective analyses.