Early Endoscopic and Histologic Response With Guselkumab Predicts Long-Term Remission in UC
Achievement of early endoscopic and histologic response with guselkumab is associated with sustained corticosteroid-free clinical remission in ulcerative colitis (UC), according to analyses from the phase 2b/3 QUASAR program and its long-term extension. The findings support treat-to-target strategies using objective markers of inflammation.
Guselkumab, a dual-acting interleukin-23p19 inhibitor, was evaluated in patients with moderately to severely active UC who responded to intravenous induction and were randomized to subcutaneous maintenance therapy. Investigators assessed whether achieving specific efficacy outcomes at maintenance baseline (week 0) and at week 44 predicted corticosteroid-free clinical remission at week 92.
Across both timepoints, early achievement of endoscopic, histologic, or composite outcomes was consistently associated with higher rates of long-term remission. At week 0, 66.8% to 77.3% of patients who achieved these endpoints went on to achieve corticosteroid-free clinical remission at week 92, compared with 48.6% to 57.6% of those who did not. Associations were stronger at week 44, where 72.1% to 81.3% of responders achieved remission at week 92 versus 44.0% to 59.4% of nonresponders.
The authors reported that “achievement of endoscopic, histologic, and composite outcomes following induction and 1 year of maintenance therapy was associated with achievement of corticosteroid-free clinical remission at week 92.” Notably, composite endpoints did not outperform individual endoscopic or histologic measures in predicting long-term outcomes.
These findings reinforce the value of objective disease assessment.
Reference
Magro F, Rubin DT, Lichtenstein GR, et al. Association of endoscopic, histologic, and composite outcomes with long-term guselkumab efficacy in ulcerative colitis: 2-year results from the QUASAR long-term extension. Presented at: Digestive Disease Week; May 2–5, 2026; Chicago, Illinois.
