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

Abstract

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.

Ustekinumab in the Treatment of Inflammatory Bowel Diseases: Evolving Paradigms

“…Other treatments are usually recommended for refractory patients or those with specific contraindications to anti-TNF-α drugs [ 108 ]. The real-life data for the use of UST in this setting are still scarce and limited by small sample sizes and large heterogeneity of therapy protocols/outcome definitions [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 35 , 45 , 47 , 48 , 55 , 61 , 62 , 63 , 68 , 69 , 70 , 71 , 72 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , …”

“…The anti-TNF-α drugs were able to achieve in the short-and long-term (12 months) remission in about 50% of patients [107]. Other treatments are usually recommended for refractory patients or those with specific contraindications to anti-TNF-α drugs [108]. The real-life data for the use of UST in this setting are still scarce and limited by small sample sizes and large heterogeneity of therapy protocols/outcome definitions [9][10][11][12][13][14][15][16][17][18][19][20][21]35,45,47,48,55,[61][62][63][68][69][70][71][72][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89].…”

Refractory Pouchitis: Antibiotic-Resistant Chronic Refractory Pouchitis

“…No association with CRP was established. The study conducted by Brewer et al34 employed a meta-analysis approach to evaluate the findings of 2 retrospective observational studies involving 26 cases of CARP and 1 retrospective observational study involving 52 cases of CARP-CD. The results indicated that the rate of complete response observed at an average of 7 months was 50% in CARP cases.…”