The Drug That Won't Let Go: 81% Remission After Three Years

Beyond Symptoms: The Gut Is Actually Healing

Remission in ulcerative colitis isn't just about feeling better. The real prize is what's happening inside the colon. Endoscopic remission, meaning a camera literally shows that the colon lining looks normal, is a much higher bar than symptom relief. It's like the difference between a car running quietly and a mechanic confirming the engine is actually fixed.

At week 140, 53.6% of patients achieved endoscopic remission, scored as a zero on the Mayo Endoscopic Score. Even more striking, 78.6% achieved histo-endoscopic mucosal improvement, which means healing was confirmed at both the visual and tissue level under a microscope.

And nearly every patient in clinical remission at that three-year mark was steroid-free for at least eight weeks. That matters enormously because steroids are the duct tape of gastroenterology: they patch things up short-term but cause bone loss, weight gain, and a cascade of side effects over time. Getting patients off steroids while keeping them in remission is one of the core goals of modern UC treatment.

Esi Lamousé-Smith, VP of Gastroenterology at J&J's Immunology division, framed it around what endoscopic remission means practically: "Patients who achieve endoscopic remission experience fewer flare-ups and are less likely to need steroids or require surgery over time."

How TREMFYA Actually Works

TREMFYA is an IL-23 inhibitor: it blocks a specific protein called interleukin-23 that drives inflammation. Think of IL-23 as a megaphone that tells immune cells to keep attacking the colon lining. TREMFYA takes away the megaphone.

What makes it slightly different from older drugs in the same family (like ustekinumab, which blocks both IL-12 and IL-23) is its precision. TREMFYA targets only the p19 subunit of IL-23, leaving IL-12 alone. It also binds to something called CD64, a receptor found on the inflammatory cells that produce IL-23 in the first place. It's essentially going after both the signal and the source.

The QUASAR study started patients on intravenous infusions during the induction phase (weeks 0, 4, and 8) and then switched them to subcutaneous injections for maintenance, either 100 mg every eight weeks or 200 mg every four weeks. As of September 2025, TREMFYA became the first and only IL-23 inhibitor with a fully subcutaneous regimen option for UC, meaning patients can eventually do everything with self-injections at home.

The Competitive Picture Is Getting Crowded

TREMFYA isn't the only IL-23 inhibitor gunning for dominance in inflammatory bowel disease. AbbVie's Skyrizi (risankizumab) is approved for UC and is a direct competitor in the same mechanistic class. Takeda's Omvoh (mirikizumab) is another p19-specific inhibitor making moves.

Direct head-to-head data between these drugs doesn't exist yet in UC, though J&J has initiated a Phase 3 trial comparing TREMFYA to Skyrizi in Crohn's disease. That trial could reshape the competitive landscape depending on results.

The broader IL-23 inhibitor market is projected to be one of the fastest-growing segments in all of immunology, driven by expanding approvals in UC, Crohn's, and psoriasis. The interleukin inhibitor market overall is expected to surpass $42 billion by 2026. For J&J, TREMFYA is a franchise cornerstone, already approved for UC, Crohn's disease (since March 2025), and psoriasis.

What This Means Going Forward

Three-year data is where durability stories start to get credible. One-year results can be a honeymoon period. Two years is encouraging. But three years with 89% of eligible patients still on treatment and over 80% in remission? That's the kind of data that changes prescribing habits.

The challenge for TREMFYA will be differentiating itself in a class that's filling up fast. Skyrizi and Omvoh are both strong competitors with their own expanding data packages. But for now, TREMFYA has the longest follow-up and some of the most impressive durability numbers in UC.

For the roughly one million Americans living with ulcerative colitis, the message from Stockholm is simple: there's now a drug with three years of evidence showing it can put the disease in remission — and keep it there. In a field where treatments fading over time has been the norm, that's a big deal.

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