Guselkumab Vs Ustekinumab in Stricturing Crohn's Disease

Efficacy of Guselkumab Versus Ustekinumab in Stricturing Crohn's Disease: A Multicenter, Prospective, Observational Cohort Study

This study intends to select patients with confirmed moderate-to-severe Crohn's disease (CD) and obstructive symptoms of intestinal stenosis, who have clear evidence of lumen stenosis caused by the disease itself through radiography or endoscopy. After the informed consent of the patients, comprehensive drug therapy with Guselkumab or Ustekinumab as the mainstay was performed. The basic information and medical history of the patients were collected, and the treatment process of the patients was followed up and recorded, and the drug regimen was adjusted according to the physician's experience and judgment. At different follow-up time points, blood, feces, tissue and other specimens of patients were collected according to the situation, and gastrointestinal endoscopy, imaging examination, laboratory index examination, self-assessment of subjects' symptoms, and nutritional risk screening were performed on the patients. This study evaluated the CD disease activity, obstructive symptoms, and radiographic or endoscopic remission in patients at different follow-up time points, and comprehensively evaluated the efficacy of ustekinumab in relieving stenotic CD and its related factors.

Study Overview

• Status: Recruiting
• Conditions: IBD - Inflammatory Bowel Disease; CD - Crohn's Disease; Stricture; Bowel
• Intervention / Treatment: Drug: Guselkumab (GUS); Drug: Ustekinumab (UST)

• Study Type: Observational
• Enrollment (Estimated): 100

Contacts and Locations

• Study Contact: Name: Yan Chen; Phone Number: 86+13757118653; Email: chenyan72_72@zju.edu.cn

Study Locations

• China
  • Zhejiang
    • Hangzhou, Zhejiang, China, 310000
      • Recruiting
      • Second Affiliated Hospital, School of Medicine, Zhejiang University
      • Contact: Yan Chen; Phone Number: 86+13757118653; Email: chenyan72_72@zju.edu.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients who will initially receive Guselkumab or Ustekinumab for the treatment of stricturing Crohn's disease

Description

Inclusion Criteria:

• Confirmed patients with moderate-to-severe Crohn's disease (CD), aged 18 to 80 years, receiving treatment with Guselkumab or Ustekinumab.
• Presence of obstructive symptoms consistent with chronic or subacute intestinal obstruction within the past 8 weeks, with confirmed postprandial abdominal pain attributable to strictures, with the exclusion of: ① mild to moderate pain (postprandial abdominal pain or abdominal pain exacerbated by diet, ameliorated with abdominal bowel sounds) without nausea, vomiting or abdominal colic; ② dietary restrictions unrelated to abdominal pain.

• Evidence of definite luminal strictures caused by the disease itself confirmed by radiographic imaging or endoscopic examination, i.e., meeting any of the following criteria:

  1. Enteric computed tomography (CT): Presence of intestinal strictures on enteric CT, with two of the three following findings at the stricture site compared with the adjacent proximal bowel: ① a >50% reduction in luminal diameter; ② a >25% increase in bowel wall thickness; ③ pre-stenotic dilation >2.5 cm.
  2. Endoscopic examination: Intestinal strictures that are impassable to the endoscope.

Exclusion Criteria:

• Patients with severe disease requiring emergency surgery or endoscopic therapeutic intervention, or those judged by the attending clinician to need a switch of medication or elective surgery within 2 months, such as those with acute severe intestinal obstruction, perforation, intra-abdominal abscess, intra-abdominal adhesion, and other conditions leading to obstruction, hemorrhage, infection, etc.
• Intestinal obstruction, intra-abdominal abscess, isolated intestinal stricture and other lesions secondary to surgery.
• Patients who have received definitive therapeutic interventions for strictures within the past 6 months, such as endoscopic balloon dilation, stricture incision, intestinal stricture plasty, surgical/manual anal dilatation, etc.
• Severe patients who remain unable to take oral intake despite enteral nutrition (EN) administration for more than 2 months.
• Patients who have used Guselkumab (GUS), Ustekinumab (UST) or other IL-23 antagonists within the past 12 months; or those with contraindications to GUS/UST, or intolerance to the study medications due to other causes (e.g., allergy to IL-23 antagonists).
• Patients with contraindications to small intestinal computed tomography (CT), such as contrast media allergy.
• Patients with relative contraindications to biological agents, such as active tuberculosis with a positive chest X-ray for pulmonary tuberculosis or a strongly positive tuberculin skin test; a history of myocardial infarction, heart failure or demyelinating neurological diseases within the past 5 years.
• Patients currently suffering from solid tumors, with a past history of lymphoma or melanoma, or undergoing chemotherapy or radiotherapy.
• Patients complicated with intestinal dysplasia (e.g., diagnosed with short bowel syndrome), colostomy or colorectal neoplasms.
• Patients complicated with active massive gastrointestinal hemorrhage, severe hepatic and renal dysfunction, active bacterial or viral infection, shock, as well as intractable vomiting and severe malabsorption syndrome.
• Pregnant or lactating patients.
• Patients with severe hemodynamic and vital sign instability, or those with rapidly progressive or end-stage diseases.
• Patients with psychiatric disorders, or those with insufficient educational level to fully understand the study content or unable to cooperate with the completion of the study.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
GUS; Guselkumab standard usage and optimized usage for the treatment of patients with symptomatic stricturing Crohn's disease	Drug: Guselkumab (GUS); ① Induction phase (Weeks 1-12): GUS 200 mg intravenously (IV) every 4 weeks for 3 doses, followed by a maintenance phase with GUS 100 mg subcutaneously (SC) every 8 weeks (for patients with all indicators within the normal range). ② Maintenance phase: Dosing adjustments shall be optimized based on the clinician's experience: If any disease activity occurs during the maintenance phase (e.g., suboptimal levels of CRP or FCP), administer GUS 200 mg SC every 4 weeks, or GUS 100 mg SC every 8 weeks plus enteral nutrition accounting for no more than 50% of the total daily energy intake. In case of persistent disease activity, administer intensive intravenous infusion of GUS 200 mg for 3 doses based on patient needs and shared decision-making.
UST; Ustekinumab standard usage and optimized usage for the treatment of patients with symptomatic stricturing Crohn's disease	Drug: Ustekinumab (UST); ① Induction phase (Weeks 1-8): UST 6 mg/kg intravenously (IV) for 1 dose, followed by UST 90 mg subcutaneously (SC) every 8 weeks. A maintenance dose of 90 mg SC shall be administered every 8 or 12 weeks thereafter on a case-by-case basis. ② Experience-based dosing optimization and adjustment: If C-reactive protein (CRP) or fecal calprotectin (FCP) levels are suboptimal, two treatment approaches shall be adopted based on patient needs and shared decision-making: intravenous intensification therapy (predominantly 2 to 3 IV doses, i.e., 260 mg or 390 mg, with a follow-up visit at 8 weeks); or 90 mg SC with a shortened administration interval (with a follow-up visit at 4 to 6 weeks). ③ The duration of Exclusive Enteral Nutrition (EEN) use shall not exceed 2 weeks. If enteral nutrition support is required beyond 2 weeks, switch to Partial Enteral Nutrition (PEN), which shall account for less than 50% of the patient's total energy requirement.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Continuation of ustekinumab	The primary endpoint was the success at week 52, defined as ustekinumab continuation with all the following criteria: (1) no use of a prohibited treatment (corticosteroids after the eight week following inclusion, parenteral nutrition, other anti-TNFs); (2) no endoscopic dilation; (3) no bowel surgery for resection of small bowel stricture; (4) no severe adverse events leading to ustekinumab withdrawal and (5) no study withdrawal whatever the reason.	up to 52 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
CT stricture improvement	CT stricture improvement was defined as resolution of prestenotic dilatation (small bowel diameter <3.0 cm); stricture resolution (normal bowel wall thickness and luminal diameter with absence of prestenotic dilation; and reduced stricture length by ≥1 mm). Intestinal ultrasound stricture improvement included normalisation of prestenotic dilation (<3.0 cm) or reduction in prestenotic dilation (≥50%).	at Week 0 and 52
General health improvement	General health improvement was measured by patient reported outcomes through health-related quality of life (Inflammatory Bowel Disease (IBD) Quality of Life Questionnaire).	at Week 0, 8, 24 and 52
Number of Participants with surgery	Surgical rates during follow-up included the proportion of patients undergoing any surgery for endoscopic dilatation and stricture resection.	up to 52 weeks

Collaborators and Investigators

• Sponsor: Second Affiliated Hospital, School of Medicine, Zhejiang University
• Collaborators: People's Hospital of Chongqing

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2026
• Primary Completion (Estimated): December 31, 2028
• Study Completion (Estimated): December 31, 2029

Study Registration Dates

• First Submitted: January 27, 2026
• First Submitted That Met QC Criteria: February 25, 2026
• First Posted (Actual): March 2, 2026

Study Record Updates

• Last Update Posted (Actual): March 2, 2026
• Last Update Submitted That Met QC Criteria: February 25, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Ustekinumab; Guselkumab; Stricturing Crohn's Disease
• Additional Relevant MeSH Terms: Pathological Conditions, Anatomical; Intestinal Diseases; Digestive System Diseases; Gastrointestinal Diseases; Gastroenteritis; Pathological Conditions, Signs and Symptoms; Constriction, Pathologic; Crohn Disease; Inflammatory Bowel Diseases; Amino Acids, Peptides, and Proteins; Proteins; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Serum Globulins; Globulins; Ustekinumab; guselkumab
• Other Study ID Numbers: 2025-1589