Ustekinumab (UST) is a humanized monoclonal antibody targeting the interleukin-12/23 pathway, which has been widely used in the therapy of Crohn’s disease. However, there are individual differences in patient response to UST. To identify the relevant factors affecting UST efficacy and provide evidence for individualized medication, this article systematically reviews and summarizes the research progress on predictive factors for UST therapy in Crohn’s disease in recent years. The content covers clinical characteristics, biomarkers, genetic factors, imaging indicators, endoscopic manifestations, drug metabolism and immune response, as well as comprehensive scoring models. It also summarizes and analyzes the predictive factors for UST dose optimization and the factors related to efficacy after optimization.