Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents

This is the peer reviewed version of the following article: Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents. Journal of Gastroenterology and Hepatology (2020): 29 April, which has been published in final form at https://doi.org/10.1111/jgh.15084. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsBiological therapies may be changing the natural history of inflammatory bowel diseases, reducing the need for surgical intervention. We aimed to assess whether the availability of anti‐TNF agents impacts the need for early surgery in Crohn's disease (CD) and ulcerative colitis (UC). Methods Retrospective, cohort study of patients diagnosed within a 6‐year period before and after the licensing of anti‐TNFs (1990‐1995 and 2007‐2012 for CD; 1995‐2000 and 2007‐2012 for UC) were identified in the ENEIDA Registry. Surgery‐free survival curves were compared between cohorts. Results A total of 7,370 CD patients (2,022 in Cohort 1 and 5,348 in Cohort 2) and 8,069 UC patients (2,938 in Cohort 1 and 5,131 in Cohort 2) were included. Immunosuppressants were used significantly earlier and more frequently in both CD and UC post‐biological cohorts. The cumulative probability of surgery was lower in CD following anti‐TNF approval (16% and 11%, 22% and 16%, and 29% and 19%, at 1, 3 and 5 years, respectively p<0.0001), though not in UC (3% and 2%, 4% and 4%, and 6% and 5% at 1, 3 and 5 years, respectively; p=0.2). Ileal involvement, older age at diagnosis and active smoking in CD, and extensive disease in UC, were independent risk factors for surgery, whereas high‐volume IBD centres (in both CD and UC) and immunosuppressant use (in CD) were protective factors. Conclusions Anti‐TNF availability was associated with a reduction in early surgery for CD (driven mainly by earlier and more widespread immunosuppressant use) but not in U

Antitumor Necrosis Factor Agents to Treat EndoscopicPostoperative Recurrence of Crohn’s Disease: A Nationwide Study With Propensity-Matched Score Analysis

INTRODUCTION:Patients with Crohn's disease experiencing endoscopic postoperative recurrence (POR) may benefit from antitumor necrosis factor (TNF) agents but scarce data on this are available. Our aim was to assess the efficacy of anti-TNF in improving mucosal lesions in patients with endoscopic POR.METHODS:Multicenter, retrospective, study of patients with Crohn's disease who underwent therapy with anti-TNF agents for endoscopic POR (Rutgeerts score > i1). Treatment outcomes were assessed by the findings in the last ileocolonoscopy performed after anti-TNF therapy was initiated. Endoscopic improvement and remission were defined as any reduction in the baseline Rutgeerts score and by a Rutgeerts score < i2, respectively.RESULTS:A total of 179 patients were included, 83 were treated with infliximab and 96 with adalimumab. Median time on anti-TNF therapy at the last endoscopic assessment was 31 months (interquartile range, 13-54). Endoscopic improvement was observed in 61%, including 42% who achieved endoscopic remission. Concomitant use of thiopurines and treatment with infliximab were associated with endoscopic improvement (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.04-4.46; P = 0.03, and OR 2.34, 95% CI 1.18-4.62; P < 0.01, respectively) and endoscopic remission (OR 3.16, 95% CI 1.65-6.05; P < 0.01, and OR 2.01, 95% CI 1.05-3.88; P = 0.04, respectively) in the multivariable logistic regression analysis. These results were confirmed in a propensity-matched score analysis.DISCUSSION:In patients with endoscopic POR, anti-TNF agents improve mucosal lesions in almost two-thirds of the patients. In this setting, concomitant use of thiopurines and use of infliximab seem to be more effective in improving mucosal lesions.Fiorella Canete received a research grant from the Societat Catalana de Digestologia

Factores de riesgo y optimización del manejo de la recurrencia postquirúrgica en la enfermedad de Crohn

Introducció: En el primer any posterior a una cirurgia intestinal resectiva, un elevat percentatge de pacients amb malaltia de Crohn (EC) desenvolupen lesions inflamatòries mucoses en el neoíleon terminal anastomosado, fenomen que es coneix com a recurrència postquirúrgica (RPQ). Aquest percentatge pot variar entre un 40-70% en funció de si es prescriu o no tractament preventiu posterior a la cirurgia, respectivament. El desenvolupament de lesions recurrents implica un major risc de desenvolupar símptomes i complicacions pròpies de la EC i, per tant, un major risc de requerir noves intervencions quirúrgiques durant el seguiment el que incrementa el risc de pèrdua de la funció intestinal. Objectius: Avaluar la història natural del desenvolupament de RPQ endoscòpica en pacients sota tractament profilàctic de manteniment amb tiopurinas, quan inicialment han previngut l'aparició d'una RPQ endoscòpica precoç en els primers 6-12 mesos després de la cirurgia, i avaluar l'eficàcia dels agents anti-TNF (infliximab o adalimumab) per a la prevenció i tractament de la RPQ endoscòpica després de la cirurgia resectiva intestinal. Mètodes: es van realitzar 3 estudis retrospectius a partir de cohorts de pacients inclosos de manera consecutiva i prospectiva. El primer estudi va ser unicéntrico, en el qual es va incloure tots els pacients amb resecció intestinal i anastomosis ileocólica que van iniciar tractament preventiu amb tiopurinas posterior a la cirurgia, amb una primera avaluació endoscòpica sense RPQ endoscòpica, per a avaluar les proporcions de RPQ en el seguiment. Un segon estudi d'àmbit estatal, multicèntric, en una cohort de pacients identificats a partir del registre ENEIDA, en els quals es va prescriure tractament preventiu de RPQ amb agents anti-TNF (adalimumab o infliximab) dins dels 3 mesos posteriors a la resecció ileocolónica i, tenien una avaluació endoscòpica dins dels 18 mesos posteriors a la cirurgia per a avaluar l'eficàcia dels agents anti-TNF. Finalment, un tercer estudi, multicèntric, en una cohort de pacients amb EC amb resecció intestinal i anastomosis ileocólica, que havien iniciat tractament amb agents anti-TNF (infliximab o adalimumab) posterior al diagnòstic de RPQ endoscòpica establerta (definida per un índex de Rutgeerts >i1), per a avaluar les taxes d'eficàcia dels agents anti-TNF. Conclusions: Les tiopurinas són eficaces a prevenir la RPQ endoscòpica a llarg termini quan han estat efectives en la prevenció de RPQ endoscòpica precoç. Els agents anti-TNF (infliximab i adalimumab), són eficaços a prevenir la RPQ, sense diferències entre tots dos, i també són eficaces a millorar i revertir la RPQ endoscòpica establerta. El tractament concomitant amb tiopurinas i la teràpia amb infliximab s'associen a una major eficàcia terapèutica a revertir lesions mucoses.Introducción: En el primer año posterior a una cirugía intestinal resectiva, un elevado porcentaje de pacientes con enfermedad de Crohn (EC) desarrollan lesiones inflamatorias mucosas en el neoíleon terminal anastomosado, fenómeno que se conoce como recurrencia postquirúrgica (RPQ). Este porcentaje puede variar entre un 40-70% en función de si se prescribe o no tratamiento preventivo posterior a la cirugía, respectivamente. El desarrollo de lesiones recurrentes implica un mayor riesgo de desarrollar síntomas y complicaciones propias de la EC y, por tanto, un mayor riesgo de requerir nuevas intervenciones quirúrgicas durante el seguimiento lo que incrementa el riesgo de pérdida de la función intestinal. Objetivos: Evaluar la historia natural del desarrollo de RPQ endoscópica en pacientes bajo tratamiento profiláctico de mantenimiento con tiopurinas, cuando inicialmente han prevenido la aparición de una RPQ endoscópica precoz en los primeros 6-12 meses tras la cirugía, y evaluar la eficacia de los agentes anti-TNF (infliximab o adalimumab) para la prevención y tratamiento de la RPQ endoscópica tras la cirugía resectiva intestinal. Métodos: se realizaron 3 estudios retrospectivos a partir de cohortes de pacientes incluidos de forma consecutiva y prospectiva. El primer estudio fue unicéntrico, en el que se incluyó todos los pacientes con resección intestinal y anastomosis ileocólica que iniciaron tratamiento preventivo con tiopurinas posterior a la cirugía, con una primera evaluación endoscópica sin RPQ endoscópica, para evaluar las proporciones de RPQ en el seguimiento. Un segundo estudio de ámbito estatal, multicéntrico, en una cohorte de pacientes identificados a partir del registro ENEIDA, en los que se prescribió tratamiento preventivo de RPQ con agentes anti-TNF (adalimumab o infliximab) dentro de los 3 meses posteriores a la resección ileocolónica y, tenían una evaluación endoscópica dentro de los 18 meses posteriores a la cirugía para evaluar la eficacia de los agentes anti-TNF. Por último, un tercer estudio, multicéntrico, en una cohorte de pacientes con EC con resección intestinal y anastomosis ileocólica, que habían iniciado tratamiento con agentes anti-TNF (infliximab o adalimumab) posterior al diagnóstico de RPQ endoscópica establecida (definida por un índice de Rutgeerts >i1), para evaluar las tasas de eficacia de los agentes anti-TNF. Conclusiones: Las tiopurinas son eficaces en prevenir la RPQ endoscópica a largo plazo cuando han sido efectivas en la prevención de RPQ endoscópica precoz. Los agentes anti-TNF (infliximab y adalimumab), son eficaces en prevenir la RPQ, sin diferencias entre ambos, y también son eficaces en mejorar y revertir la RPQ endoscópica establecida. El tratamiento concomitante con tiopurinas y la terapia con infliximab se asocian a una mayor eficacia terapéutica en revertir lesiones mucosas.Introduction: In the first year after ileocecal resection with anastomosis a high percentage of patients with Crohn's disease (CD) develop mucosal inflammatory lesions in the neoterminal ileum, a phenomenon known as postoperative recurrence (POR). This percentage ranges between 40-70% in patients without or with preventive therapy prescribed after surgery, respectively. The development of mucosal lesions involves a greater risk of developing symptoms and complications and a greater risk of requiring new surgical interventions during follow-up, which increases the risk of loss of intestinal function. Aims: To evaluate the natural history of the development of endoscopic POR in patients receiving prophylactic maintenance therapy with thiopurines, when initially they have prevented the appearance of early endoscopic POR in the first 6-12 months after surgery, and to evaluate the efficacy of the anti-TNF agents (infliximab or adalimumab) for the prevention and treatment of endoscopic POR after ileocecal resection with anastomosis. Methods: Three retrospective studies have been performed from cohorts of patients consecutively and prospectively included. The first study included all patients with intestinal resection and ileocolonic anastomosis who started preventive therapy with thiopurines after surgery with a first endoscopic assessment without endoscopic POR, to evaluate the long-term outcomes of POR in these patients. The second study was a multicenter, nationwide study that included a cohort of patients identified from the ENEIDA registry, in whom preventive therapy of POR with anti-TNF agents (adalimumab or infliximab) was prescribed within 3 months after ileocolonic resection and who had an endoscopic assessment within 18 months after surgery, to assess the efficacy of anti-TNF agents. Finally, a third multicenter study included a cohort of patients who had started treatment with anti-TNF agents (infliximab or adalimumab) after the diagnosis of established endoscopic POR (defined by an index of Rutgeerts >i1), to assess the efficacy of anti-TNF agents. Conclusions: Thiopurines are effective in preventing long-term endoscopic POR when they have been effective in preventing early endoscopic POR. Anti-TNF agents (infliximab and adalimumab) are effective in preventing POR, with no differences between the two anti-TNF agents, and are also effective in improving and reverting postoperative mucosal lesions (established POR). Concomitant treatment with thiopurines and infliximab therapy are associated with greater therapeutic efficacy in reverting mucosal lesions

Factores de riesgo y optimización del manejo de la recurrencia postquirúrgica en la enfermedad de Crohn

Introducció: En el primer any posterior a una cirurgia intestinal resectiva, un elevat percentatge de pacients amb malaltia de Crohn (EC) desenvolupen lesions inflamatòries mucoses en el neoíleon terminal anastomosado, fenomen que es coneix com a recurrència postquirúrgica (RPQ). Aquest percentatge pot variar entre un 40-70% en funció de si es prescriu o no tractament preventiu posterior a la cirurgia, respectivament. El desenvolupament de lesions recurrents implica un major risc de desenvolupar símptomes i complicacions pròpies de la EC i, per tant, un major risc de requerir noves intervencions quirúrgiques durant el seguiment el que incrementa el risc de pèrdua de la funció intestinal. Objectius: Avaluar la història natural del desenvolupament de RPQ endoscòpica en pacients sota tractament profilàctic de manteniment amb tiopurinas, quan inicialment han previngut l’aparició d’una RPQ endoscòpica precoç en els primers 6-12 mesos després de la cirurgia, i avaluar l’eficàcia dels agents anti-TNF (infliximab o adalimumab) per a la prevenció i tractament de la RPQ endoscòpica després de la cirurgia resectiva intestinal. Mètodes: es van realitzar 3 estudis retrospectius a partir de cohorts de pacients inclosos de manera consecutiva i prospectiva. El primer estudi va ser unicéntrico, en el qual es va incloure tots els pacients amb resecció intestinal i anastomosis ileocólica que van iniciar tractament preventiu amb tiopurinas posterior a la cirurgia, amb una primera avaluació endoscòpica sense RPQ endoscòpica, per a avaluar les proporcions de RPQ en el seguiment. Un segon estudi d’àmbit estatal, multicèntric, en una cohort de pacients identificats a partir del registre ENEIDA, en els quals es va prescriure tractament preventiu de RPQ amb agents anti-TNF (adalimumab o infliximab) dins dels 3 mesos posteriors a la resecció ileocolónica i, tenien una avaluació endoscòpica dins dels 18 mesos posteriors a la cirurgia per a avaluar l’eficàcia dels agents anti-TNF. Finalment, un tercer estudi, multicèntric, en una cohort de pacients amb EC amb resecció intestinal i anastomosis ileocólica, que havien iniciat tractament amb agents anti-TNF (infliximab o adalimumab) posterior al diagnòstic de RPQ endoscòpica establerta (definida per un índex de Rutgeerts >i1), per a avaluar les taxes d’eficàcia dels agents anti-TNF. Conclusions: Les tiopurinas són eficaces a prevenir la RPQ endoscòpica a llarg termini quan han estat efectives en la prevenció de RPQ endoscòpica precoç. Els agents anti-TNF (infliximab i adalimumab), són eficaços a prevenir la RPQ, sense diferències entre tots dos, i també són eficaces a millorar i revertir la RPQ endoscòpica establerta. El tractament concomitant amb tiopurinas i la teràpia amb infliximab s’associen a una major eficàcia terapèutica a revertir lesions mucoses.Introducción: En el primer año posterior a una cirugía intestinal resectiva, un elevado porcentaje de pacientes con enfermedad de Crohn (EC) desarrollan lesiones inflamatorias mucosas en el neoíleon terminal anastomosado, fenómeno que se conoce como recurrencia postquirúrgica (RPQ). Este porcentaje puede variar entre un 40-70% en función de si se prescribe o no tratamiento preventivo posterior a la cirugía, respectivamente. El desarrollo de lesiones recurrentes implica un mayor riesgo de desarrollar síntomas y complicaciones propias de la EC y, por tanto, un mayor riesgo de requerir nuevas intervenciones quirúrgicas durante el seguimiento lo que incrementa el riesgo de pérdida de la función intestinal. Objetivos: Evaluar la historia natural del desarrollo de RPQ endoscópica en pacientes bajo tratamiento profiláctico de mantenimiento con tiopurinas, cuando inicialmente han prevenido la aparición de una RPQ endoscópica precoz en los primeros 6-12 meses tras la cirugía, y evaluar la eficacia de los agentes anti-TNF (infliximab o adalimumab) para la prevención y tratamiento de la RPQ endoscópica tras la cirugía resectiva intestinal. Métodos: se realizaron 3 estudios retrospectivos a partir de cohortes de pacientes incluidos de forma consecutiva y prospectiva. El primer estudio fue unicéntrico, en el que se incluyó todos los pacientes con resección intestinal y anastomosis ileocólica que iniciaron tratamiento preventivo con tiopurinas posterior a la cirugía, con una primera evaluación endoscópica sin RPQ endoscópica, para evaluar las proporciones de RPQ en el seguimiento. Un segundo estudio de ámbito estatal, multicéntrico, en una cohorte de pacientes identificados a partir del registro ENEIDA, en los que se prescribió tratamiento preventivo de RPQ con agentes anti-TNF (adalimumab o infliximab) dentro de los 3 meses posteriores a la resección ileocolónica y, tenían una evaluación endoscópica dentro de los 18 meses posteriores a la cirugía para evaluar la eficacia de los agentes anti-TNF. Por último, un tercer estudio, multicéntrico, en una cohorte de pacientes con EC con resección intestinal y anastomosis ileocólica, que habían iniciado tratamiento con agentes anti-TNF (infliximab o adalimumab) posterior al diagnóstico de RPQ endoscópica establecida (definida por un índice de Rutgeerts >i1), para evaluar las tasas de eficacia de los agentes anti-TNF. Conclusiones: Las tiopurinas son eficaces en prevenir la RPQ endoscópica a largo plazo cuando han sido efectivas en la prevención de RPQ endoscópica precoz. Los agentes anti-TNF (infliximab y adalimumab), son eficaces en prevenir la RPQ, sin diferencias entre ambos, y también son eficaces en mejorar y revertir la RPQ endoscópica establecida. El tratamiento concomitante con tiopurinas y la terapia con infliximab se asocian a una mayor eficacia terapéutica en revertir lesiones mucosas.Introduction: In the first year after ileocecal resection with anastomosis a high percentage of patients with Crohn’s disease (CD) develop mucosal inflammatory lesions in the neoterminal ileum, a phenomenon known as postoperative recurrence (POR). This percentage ranges between 40-70% in patients without or with preventive therapy prescribed after surgery, respectively. The development of mucosal lesions involves a greater risk of developing symptoms and complications and a greater risk of requiring new surgical interventions during follow-up, which increases the risk of loss of intestinal function. Aims: To evaluate the natural history of the development of endoscopic POR in patients receiving prophylactic maintenance therapy with thiopurines, when initially they have prevented the appearance of early endoscopic POR in the first 6-12 months after surgery, and to evaluate the efficacy of the anti-TNF agents (infliximab or adalimumab) for the prevention and treatment of endoscopic POR after ileocecal resection with anastomosis. Methods: Three retrospective studies have been performed from cohorts of patients consecutively and prospectively included. The first study included all patients with intestinal resection and ileocolonic anastomosis who started preventive therapy with thiopurines after surgery with a first endoscopic assessment without endoscopic POR, to evaluate the long-term outcomes of POR in these patients. The second study was a multicenter, nationwide study that included a cohort of patients identified from the ENEIDA registry, in whom preventive therapy of POR with anti-TNF agents (adalimumab or infliximab) was prescribed within 3 months after ileocolonic resection and who had an endoscopic assessment within 18 months after surgery, to assess the efficacy of anti-TNF agents. Finally, a third multicenter study included a cohort of patients who had started treatment with anti-TNF agents (infliximab or adalimumab) after the diagnosis of established endoscopic POR (defined by an index of Rutgeerts >i1), to assess the efficacy of anti-TNF agents. Conclusions: Thiopurines are effective in preventing long-term endoscopic POR when they have been effective in preventing early endoscopic POR. Anti-TNF agents (infliximab and adalimumab) are effective in preventing POR, with no differences between the two anti-TNF agents, and are also effective in improving and reverting postoperative mucosal lesions (established POR). Concomitant treatment with thiopurines and infliximab therapy are associated with greater therapeutic efficacy in reverting mucosal lesions.Universitat Autònoma de Barcelona. Programa de Doctorat en Medicin

Non-hepatic solid organ transplant in patients with inflammatory bowel disease: an ECCO CONFER Multicentre Case Series

peer reviewe

Nivel de conocimiento sobre VPH en estudiantes de la Universidad del Pacífico

Introducción. El virus del papiloma humano (VPH) es una infección viral más habitual del aparato reproductor y causa diversos trastornos, tanto en hombres como en mujeres, y se considera como el principal agente para el desarrollo del cáncer cervicouterino. Objetivo. Determinar el nivel de conocimiento sobre el VPH de las alumnas del segundo año de las diferentes carreras de la Universidad del Pacífico Sede Asunción en el año 2023. Materiales y Métodos. Se realizó un estudio observacional, descriptivo de corte transversal en alumnas del segundo año de las diferentes carreras de la Universidad del Pacifico en el 2023, mediante una encuesta de conocimiento, influencia y métodos para evitar el contagio del VPH. Se aplicó la estadística descriptiva utilizando el programa EpiDat 4.2. Resultados.  Participaron 95 alumnas, el 49,92% conoce que el VPH es una infección viral, el 87,37% que su síntoma más común son las verrugas genitales, el 91,58% sabe que la infección por VPH afecta a ambos sexos, el 90,53% que se puede transmitir por vía sexual, 71,58% sabe que puede producir cáncer de cuello uterino y el 86,32% conoce que la vacunación es la principal medida de prevención. El 48% de las estudiantes tuvieron un buen nivel de conocimiento global sobre el VPH. Conclusión. El nivel insuficiente de conocimiento sobre VHP refleja la necesidad de realizar fortalecer el programa educativo universitario y campañas educativas con respecto al VPH y el cáncer de cuello uterino

Granulocyte–monocyte apheresis: an alternative combination therapy after loss of response to anti-TNF agents in ulcerative colitis

[Objective] To evaluate the effectiveness and safety of the combination of granulocyte–monocyte apheresis (GMA) after loss of response (LOR) to anti-tumor necrosis factor (TNF) agents in ulcerative colitis (UC).[Materials and methods] A retrospective, multicenter study was performed in 11 inflammatory bowel disease (IBD) Units. Clinical remission was defined as a partial Mayo score ≤2. The effectiveness of the treatment was evaluated by the partial Mayo score and the rate of anti-TNF intensification, switch, swap or colectomy.[Results] Forty-seven patients with ulcerative colitis were included (mean age 35 years, mean disease duration 52 months, 66% male and 59% extensive colitis). Twenty-three subjects were receiving infliximab, eighteen adalimumab and six golimumab. GMA was combined after a primary non-response (49%) or secondary loss of response (51%) to anti-TNF therapy. We observed a significant decrease in partial Mayo score and fecal calprotectin after GMA. Fifteen patients (32%) responded to the combination therapy without anti-TNF intensification, switch, swap or colectomy. Eight patients (17%) underwent colectomy. Two patients (4%) presented adverse events related to the technique.[Conclusions] Combination of GMA and anti-tumor necrosis factor is a safe and effective treatment after the loss of response to these biologic agents, with a significant decrease of the clinical disease activity and biomarkers, in a population with limited therapeutic alternatives

Interstitial and Granulomatous lung disease in inflammatory bowel disease patients.

BACKGROUND: Interstitial lung [ILD] disease and granulomatous lung disease [GLD] are rare respiratory disorders that have been associated with inflammatory bowel disease [IBD]. Clinical presentation is polymorphic and aetiology is unclear. METHODS: This was an ECCO-CONFER project. Cases of concomitant ILD or GLD and IBD, or drug-induced ILD/GLD, were collected. The criteria for diagnosing ILD and GLD were based on definitions from the American Thoracic Society and the European Respiratory Society and on the discretion of reporting clinician. RESULTS: We identified 31 patients with ILD. The majority had ulcerative colitis [UC] [n = 22]. Drug-related ILD was found in 64% of these patients, 25 patients [80.6%] required hospitalisation, and one required non-invasive ventilation. The causative drug was stopped in all drug-related ILD, and 87% of patients received systemic steroids. At follow-up, 16% of patients had no respiratory symptoms, 16% had partial improvement, 55% had ongoing symptoms, and there were no data in 13%. One patient was referred for lung transplantation, and one death from lung fibrosis was reported. We also identified 22 GLD patients: most had Crohn's disease [CD] [n = 17]. Drug-related GLD was found in 36% of patients and 10 patients [45.4%] required hospitalisation. The causative drug was stopped in all drug-related GLD, and 81% of patients received systemic steroids. Remission of both conditions was achieved in almost all patients. CONCLUSIONS: ILD and GLD, although rare, can cause significant morbidity. In our series, over half of cases were drug-related and therefore focused pharmacovigilance is needed to identify and manage these cases

Effectiveness and safety of ustekinumab in ulcerative colitis: Real-world evidence from the ENEIDA registry

Abstract Background: The development program (UNIFI) has shown promising results of ustekinumab in ulcerative colitis (UC) treatment that should be confirmed in clinical practice. Aims: To evaluate the durability, effectiveness and safety of ustekinumab in UC in real-life. Methods: Patients included in the prospectively maintained ENEIDA registry who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score (PMS) >2] were included. Clinical activity and effectiveness were defined based on PMS. Short-term response was assessed at week 16. Results: A total of 95 patients were included. At week 16, 53% of patients had response (including 35% of patients in remission). In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with lower likelihood of achieving remission. Remission was achieved in 39% and 33% of patients at weeks 24 and 52, respectively. Thirty-six percent of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at week 16, 63% at week 56, and 59% at week 72; primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. Conclusions: Ustekinumab is effective both in the short and the long-term in real-life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinuma