Gastroenterology AdvisorMirikizumab Treatment Effective for Ulcerative Colitis Up to 152 Weeks

This article reports interim results from the ongoing LUCENT-3 open-label extension study evaluating mirikizumab for moderately-to-severely active ulcerative colitis through 152 weeks of continuous treatment. The evidence comes from a relatively large cohort (N=316) with limitations including open-label design, focus on induction responders, and underrepresentation of Black patients.

⚕️Key Clinical Considerations⚕️

• Mirikizumab showed sustained efficacy at 152 weeks with 71.6% of week-52 responders maintaining clinical response using nonresponder imputation, and higher rates (81.6% response, 56.1% remission) using modified nonresponder imputation.
• Treatment demonstrated consistent efficacy in maintaining symptomatic remission (69.6%), histologic-endoscopic mucosal remission (62.8%), and bowel urgency remission (66.9%) at week 152 using modified NRI.
• Comparable efficacy was observed in both biologic-naïve and biologic-failure patients, suggesting effectiveness across treatment histories.
• Patients maintained clinically meaningful improvements in key symptoms including stool frequency, rectal bleeding, and abdominal pain throughout the extended treatment period.
• Quality of life benefits were substantial, with 76.9% of clinical responders and 79.3% of clinical remitters achieving IBDQ remission at week 152, regardless of prior biologic exposure.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Mirikizumab represents a potential long-term treatment option for patients with moderately-to-severely active UC, demonstrating sustained efficacy through 152 weeks of continuous treatment for patients with and without previous biologic failure. When discussing treatment expectations, clinicians can reference the high maintenance rates for both symptomatic and endoscopic outcomes.
• Safety Considerations: The safety profile appears manageable with severe treatment-emergent adverse events in 7.4%, serious adverse events in 8.8%, and treatment discontinuation due to adverse events in 5.3% of patients. COVID-19 was noted as the most common treatment-emergent adverse event (22.4%).
• Practice Integration: When considering biologic therapy sequencing, mirikizumab’s similar efficacy in both biologic-naïve and biologic-failure populations may influence positioning in treatment algorithms for moderate-to-severe UC patients requiring long-term management.
• Action Items: Clinicians should monitor for early response patterns, as the study focused on induction responders, and consider comprehensive assessment including symptomatic, endoscopic, and quality of life outcomes when evaluating treatment success.

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