A 34-year-old woman with moderately active ulcerative colitis (Mayo score 8) has failed two biologics (infliximab lost response due to antibodies; vedolizumab inadequate response). She tests positive for anti-nuclear antibody. The current biologic target most appropriate for this refractory UC is:
- A Ustekinumab (anti-IL-12/23 targeting the p40 subunit) ✓
- B Rituximab
- C Etanercept
- D Certolizumab pegol
Correct answer: A. Ustekinumab (anti-IL-12/23 targeting the p40 subunit)
Explanation
Ustekinumab (anti-IL-12/23p40) is approved for moderate-to-severe UC and Crohn's disease and is an appropriate biologic after failure of both TNF inhibitors and vedolizumab, providing a different mechanism of action. The UNIFI trial demonstrated its efficacy in UC. Tofacitinib (JAK inhibitor) and ozanimod are also approved alternatives. Rituximab (anti-CD20) is not approved for IBD. Etanercept has no evidence in IBD. Certolizumab is approved for Crohn's disease but not UC in most guidelines, and the patient has already failed anti-TNF therapy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.