Outcome of biological therapies in chronic antibiotic-refractory pouchitis: A retrospective single-centre experience.

Abstract

Background:

In limited retrospective series, infliximab, adalimumab and vedolizumab have demonstrated efficacy in chronic antibiotic-refractory pouchitis. Here, we report single-centre data of all biological therapies in refractory pouchitis.

Methods:

We retrospectively assessed all records from patients with ulcerative colitis and ileal pouch -anal anastomosis who received infliximab, adalimumab or vedolizumab for pouchitis. Clinically relevant remission, defined as a modified Pouchitis Disease Activity Index <5 and a reduction of modified Pouchitis Disease Activity Index ≥2 points from baseline, was assessed at week 14.

Results:

Thirty-three unique patients were identified. Prior to colectomy, patients had been exposed to cyclosporine (n = 14), infliximab (n = 12), adalimumab (n = 3), and/or vedolizumab (n = 3). All developed chronic antibiotic-refractory pouchitis, for which they received infliximab (n = 23), adalimumab (n = 13) or vedolizumab (n = 15). Clinically relevant remission was observed in 43.5% of patients in the infliximab group, and in 38.5% and 60.0% in the adalimumab and vedolizumab group, respectively. In the long-term, significantly more patients continued vedolizumab compared to anti-tumour necrosis factor (anti-TNF) therapy (hazard ratio 3.0, p = 0.04). Adverse events (mainly infusion reactions) explained 40.7% of the patients discontinuing anti-TNF therapy, whereas discontinuation of vedolizumab was only related to insufficient efficacy. Four patients eventually required a permanent ileostomy.

Conclusion:

In this case series of chronic antibiotic-refractory pouchitis, biological therapy was effective in the majority of patients and only a minority eventually required a permanent ileostomy. The use of anti-TNF agents was hampered by a high rate of adverse events, partly related to immunogenicity as some patients had been exposed to anti-TNF prior to colectomy. Vedolizumab was also efficacious and may provide a safe alternative in these chronic antibiotic-refractory pouchitis patients.

• Authors: Bram Verstockt, Charlotte Claeys, Gert De Hertogh, Gert Van Assche, Albert Wolthuis, André D'Hoore, Séverine Vermeire, Marc Ferrante
• Journal: United European gastroenterology journal (United European Gastroenterol J) Vol. 7 Issue 9 Pg. 1215-1225 (11 2019) ISSN: 2050-6406 [Print] England
• PMID: 31700634 (Publication Type: Journal Article)
• Copyright: © Author(s) 2019.

Chemical References

• Anti-Bacterial Agents
• Antibodies, Monoclonal, Humanized
• Biological Products
• Gastrointestinal Agents
• Tumor Necrosis Factor Inhibitors
• vedolizumab
• Infliximab
• Adalimumab

Topics

• Adalimumab (therapeutic use)
• Adult
• Anti-Bacterial Agents (therapeutic use)
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Biological Products (therapeutic use)
• Chronic Disease
• Colitis, Ulcerative (surgery)
• Female
• Gastrointestinal Agents (therapeutic use)
• Humans
• Infliximab (therapeutic use)
• Male
• Middle Aged
• Pouchitis (drug therapy)
• Proctocolectomy, Restorative
• Retrospective Studies
• Treatment Failure
• Treatment Outcome
• Tumor Necrosis Factor Inhibitors (therapeutic use)