Ustekinumab Treatment Persistence in Ulcerative Colitis Patients Unresponsive to Biologic Treatment: A Single-Center Real-World Experience

Ustekinumab is an effective biological agent for the treatment of ulcerative colitis (UC); however, real-world data on treatment persistence and factors affecting drug survival in biologic-experienced patients remain limited. This retrospective cohort study aimed to evaluate ustekinumab treatment persistence and identify factors associated with treatment discontinuation in UC patients treated between January 2021 and December 2025. Treatment persistence was defined as the time from treatment initiation to discontinuation and was analyzed using the Kaplan–Meier method. A total of 42 biologic-experienced UC patients were included. The 12-month and 24-month treatment persistence rates were 90.5% and 85.7%, respectively, and 14.3% of patients discontinued treatment during follow-up. Surgical history was significantly associated with higher treatment discontinuation rates (p=0.026), and patients with prior surgery had significantly lower treatment persistence (log-rank p<0.001). Female sex was also associated with lower treatment persistence (log-rank p=0.045). Other clinical variables, including smoking status, disease extent, prior biologic exposure, and extraintestinal manifestations, were not significantly associated with treatment persistence. In conclusion, ustekinumab demonstrates high treatment persistence in biologic-experienced UC patients in real-world practice, and surgical history and female sex may be associated with lower treatment persistence. Larger prospective studies are needed to confirm these findings.