A Study to Evaluate the Efficacy and Safety of Ustekinumab in the Treatment of Anti-TNF(Alpha) Refractory Participants With Active Radiographic Axial Spondyloarthritis

This is a Phase 3, multicenter (when more than one hospital or medical school team work on a
medical research study), randomized (study medication assigned to participants by chance),
double-blind (neither the researchers nor the participants know what treatment the
participant is receiving), placebo-controlled (an inactive substance; a pretend treatment
[with no drug in it] that is compared in a clinical trial with a drug to test if the drug has
a real effect) study. The study consists of 3 phases; Screening (up to 8 weeks), Treatment
phase: placebo-controlled (Week 0 to 24) and active treatment (Week 24 to Week 52), and
Safety Follow-up (up to 12 weeks). Participants will be randomly assigned to 1 of 3 treatment
groups: placebo, ustekinumab 45 mg and ustekinumab 90 mg. The total duration of study will be
up to 64 weeks. Participants will be primarily assessed for Assessment of SpondyloArthritis
International Society (ASAS) 40 response at Week 24. Participants' safety will be monitored
throughout the trial.

Inclusion Criteria:

- Participants must have a diagnosis of definite ankylosing spondylitis (AS), as defined
by the modified 1984 New York criteria. The radiographic criterion must be confirmed
by a central xray reader and at least 1 clinical criterion must be met

- Participants must have symptoms of active disease at screening and at baseline, as
evidenced by both a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score
of greater than or equal to (>=4) and a visual analog scale (VAS) score for total back
pain of >=4, each on a scale of 0 to 10

- Participants with elevated high sensitivity C-reactive protein (hsCRP) level of
>=0.300 milligram per deciliter (mg/dL) at screening

- Refractory by either lack of benefit or documented intolerance to 1 and no more than 1
anti-TNF(alpha) agent

- Inadequate response to at least 2 nonsteroidal anti-inflammatory drugs (NSAIDs) over a
4-week period in total with maximal doses of NSAID(s), or is unable to receive a full
4 weeks of maximal NSAID therapy because of intolerance, toxicity, or
contraindications to NSAIDs.

- Participants with complete ankylosis of the spine are permitted to be included in the
study, but will be limited to approximately 10 percent (%) of the study population

Exclusion Criteria:

- Participants who have other inflammatory diseases that might confound the evaluations
of benefit from the ustekinumab therapy, including but not limited to, rheumatoid
arthritis, systemic lupus erythematosus, or Lyme disease

- Participants who have received infliximab or infliximab biosimilar, within 12 weeks of
the first study agent administration; have received adalimumab, adalimumab biosimilar,
or certolizumab pegol within 6 weeks of the first study agent administration; have
received etanercept or etanercept biosimilar within 6 weeks of the first study agent
administration

- Participants who have ever received golimumab

- Participants who are pregnant, nursing, or planning a pregnancy or fathering a child
while enrolled in the study or within 5 months after receiving the last administration
of study agent

- Participants who have received any systemic immunosuppressives or disease-modifying
antirheumatic drugs (DMARDs) other than methotrexate (MTX), sulfasalazine (SSZ), or
hydroxychloroquine (HCQ) within 4 weeks prior to first administration of study agent.
Medications in these categories include, but are not limited to leflunomide,
chloroquine, azathioprine, cyclosporine, mycophenolate mofetil, gold, and
penicillamine