P459 Vedolizumab for the treatment of chronic pouchitis: the Edinburgh experience

Cesano, S.; Jones, Gareth‐Rhys; Jenkinson, P; Shand, AG; Arnott, Ian; Plevris, Nikolas

doi:10.1093/ecco-jcc/jjy222.583

Cited by 3 publications

(5 citation statements)

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“…In 2 studies, assessment was done based on mPDAI 25,28,30,38. Three studies defined clinical improvement as a reduction in clinical PDAI of ≥2 24,26,32…”

Section: Resultsmentioning

confidence: 99%

“…Three studies included were published only as abstracts 27,28,32. There were 2 prospective28,36 and 3 retrospective32,34,38 case series included.…”

Section: Resultsmentioning

confidence: 99%

“…25,28,30,38 Three studies defined clinical improvement as a reduction in clinical PDAI of ≥ 2. 24,26,32…”

Section: Clinical Response/improvementmentioning

confidence: 99%

“…Three studies included were published only as abstracts. 27,28,32 There were 2 prospective 28,36 and 3 retrospective 32,34,38 case series included. One prospective randomized controlled trial, 26 4 retrospective cohorts 24,29,30,40 and 2 prospective cohort studies 35,37 were included.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

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Safety and Efficacy of Biological Therapy in Chronic Antibiotic Refractory Pouchitis

Chandan

Mohan

Kumar

et al. 2021

Journal of Clinical Gastroenterology

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Background: Pouchitis is the most common long-term complication after ileal pouch-anal anastomosis in patients with ulcerative colitis. Those with ≥3 episodes of pouchitis/year and symptoms despite antibiotics are considered to have chronic antibiotic refractory pouchitis (CARP). While several agents including probiotics, steroids and immunomodulators have been used, treatment of CARP remains challenging. We conducted a systematic review and meta-analysis evaluating the safety and efficacy of various biological agents in treatment of CARP. Methods: Multiple databases were searched through June 2020 for studies that reported the efficacy and safety of biological therapy including antitumor necrosis factor-alpha agents [infliximab (IFX) and adalimumab (ADA)], vedolizumab (VDZ), and ustekinumab in CARP. We excluded studies on Crohn’s like and/or other inflammatory complications of the pouch. Meta-analysis was performed to calculate pooled rates of clinical as well as endoscopic improvement and remission. Results: We included 15 studies with 311 patients in our final analysis. Ninety-two patients were treated with IFX, 42 with ADA, 144 with VDZ and 33 with ustekinumab. Pooled rate of clinical improvement was 71.4%, 58.2%, 47.9% and clinical remission was 65.7%, 31%, 47.4% with IFX, ADA, and VDZ, respectively. Pooled rate of endoscopic improvement was achieved in 61.2% patients treated with VDZ while endoscopic remission was achieved in 70.3% patients treated with IFX. Adverse events were reported in 3.9% patients. Conclusion: Biologic therapy is safe and effective in the treatment of CARP.

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“…In 2 studies, assessment was done based on mPDAI 25,28,30,38. Three studies defined clinical improvement as a reduction in clinical PDAI of ≥2 24,26,32…”

Section: Resultsmentioning

confidence: 99%

“…Three studies included were published only as abstracts 27,28,32. There were 2 prospective28,36 and 3 retrospective32,34,38 case series included.…”

Section: Resultsmentioning

confidence: 99%

“…25,28,30,38 Three studies defined clinical improvement as a reduction in clinical PDAI of ≥ 2. 24,26,32…”

Section: Clinical Response/improvementmentioning

confidence: 99%

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

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Safety and Efficacy of Biological Therapy in Chronic Antibiotic Refractory Pouchitis

Chandan

Mohan

Kumar

et al. 2021

Journal of Clinical Gastroenterology

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“…We identified 7 studies that used vedolizumab for the treatment of inflammatory conditions of the pouch. Four studies looked at the outcomes in patients diagnosed with CARP, 44,46,47,50 1 in patients with CD of the pouch 48 and 2 studies reported outcomes for both conditions. 45,49 For CARP, a total of 91 patients received treatment with vedolizumab.…”

Section: Vedolizumabmentioning

confidence: 99%

Use of Biologics for the Treatment of Inflammatory Conditions of the Pouch

Godoy-Brewer

Salem

Limketkai

et al. 2023

Journal of Clinical Gastroenterology

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Background: Patients with medically-refractory ulcerative colitis or advanced neoplasia are often offered an ileal-pouch-anal anastomosis to restore bowel continuity. However, up to 50% of patients can suffer from inflammatory conditions of the pouch, some of which require biological therapy to treat. The aim of this study was to determine the efficacy of each biological agent for the treatment of inflammatory conditions of the pouch. Materials and Methods:A comprehensive literature search was performed in the major databases from inception through February 11, 2020, for studies assessing the efficacy of biologics in chronic antibiotic-refractory pouchitis (CARP) and Crohn's disease (CD) of the pouch. Both prospective and retrospective studies were included. The primary outcomes of interest were complete and partial responses were defined within each study. χ 2 test was used to compare variables.Results: Thirty-four studies were included in the systematic review and meta-analysis. Sixteen studies (N = 247) evaluated the use of infliximab (IFX), showing complete response in 50.7% and partial response in 28.1% for CARP, and complete response in 66.7% and partial response in 20% for CD of the pouch. Seven studies (n = 107) assessed the efficacy of adalimumab. For CARP, 33.3% of patients had a complete response, and 38.1% had a partial response, whereas for CD of the pouch, 47.7% experienced a complete response, and 24.6% had a partial response. Three studies (n = 78) reported outcomes with the use of ustekinumab, showing 50% complete response and 3.8% partial response for CARP. For the CD of the pouch, 5.8% had a complete response and 78.8% had a partial response. Seven studies (n = 151) reported the efficacy of vedolizumab, showing 28.4% complete response and 43.2% partial response in patients with CARP, whereas 63% of patients experienced partial response in CD of the pouch. IFX had higher rates of complete response in CARP compared with adalimumab (P = 0.04) and compared with vedolizumab (P = 0.005), but not compared with ustekinumab (P = 0.95). There were no new safety signals reported in any of the studies.Conclusions: Biologics are safe and efficacious in the treatment of chronic, refractory inflammatory conditions of the pouch. IFX seems to be more efficacious than adalimumab and vedolizumab for CARP. Further prospective, head-to-head evaluations are needed to compare biological therapies in the treatment of CARP and CD of the pouch.

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AGA Clinical Practice Guideline on the Management of Pouchitis and Inflammatory Pouch Disorders

Barnes,

Agrawal,

Syal

et al. 2024

Gastroenterology

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P459 Vedolizumab for the treatment of chronic pouchitis: the Edinburgh experience

Cited by 3 publications

References 0 publications

Safety and Efficacy of Biological Therapy in Chronic Antibiotic Refractory Pouchitis

Safety and Efficacy of Biological Therapy in Chronic Antibiotic Refractory Pouchitis

Use of Biologics for the Treatment of Inflammatory Conditions of the Pouch

AGA Clinical Practice Guideline on the Management of Pouchitis and Inflammatory Pouch Disorders

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