Clinical and Radiological Outcomes of Ustekinumab in Pediatric Perianal Crohn’S Disease: A Multicenter Retrospective Study From the Pediatric Ibd Porto Group of Espghan Publisher Pubmed

Summary: Can ustekinumab help children with perianal Crohn’s? In 50 patients, about 48% reached clinical remission at one year, while fewer showed MRI healing. #CrohnsDisease #Pediatrics

Orlin I ; Younis B ; Gasparetto M ; Yerushalmy Feler A ; Norsa L ; Sokollik C ; Rohani P ; Zarubova K ; D Arcangelo G ; Pochesci S ; Lozano Ruf A ; Kolho K L ; Griffiths A ; Rinawi F
Source: Inflammatory Bowel Diseases Published:2026

Abstract

Background: Perianal Crohn’s disease (pCD) is a severe pediatric phenotype with high morbidity. Although antitumor necrosis factor (TNF) agents are first-line therapy, remission is not achieved in a subset of patients. We aimed to evaluate clinical and radiological outcomes of ustekinumab (UST) in pediatric patients with pCD. Methods: This is a multicenter retrospective study including pediatric patients with pCD treated with UST between 2016 and 2023. Primary outcomes were clinical and radiological remission at predefined time points. Clinical remission was defined as absence of fistula drainage without antibiotics or unplanned perianal interventions. Radiological remission was defined as a Pediatric MRI-Based perianal Crohn’s Disease (PEMPAC) score of <10 on pelvic MRI. Results: Fifty patients were included, of whom 2 were anti-TNF-naive. The median age at UST initiation was 15 years (IQR 12.4-16.2). Clinical remission was observed in 46% (23/50; P = .006 vs baseline), 48% (23/48; P = .036 vs baseline), and 42% (19/45; P = .13 vs baseline) at weeks 26, 52, and 104, respectively. Radiological remission was 29% (10/34) and 30% (13/43) at weeks 52 and 104, respectively (both P < .01 vs baseline). In multivariable analysis, higher baseline PEMPAC scores were independently associated with lower odds of both clinical (P < .01; OR 0.88, 95% CI 0.68-0.95) and radiological remission (P < .01; OR 0.81, 95% CI 0.62-0.94). Conclusions: UST was associated with perianal clinical remission in a substantial proportion of pediatric patients, approaching 50% at 1 year, and radiological healing in about one-third at 2 years, supporting its potential role in pediatric pCD. © The Author(s) 2026. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)