Saurabh Chandan1, Babu P Mohan2, Anand Kumar3, Shahab R Khan4, Ojasvini C Chandan5, Lena L Kassab6, Suresh Ponnada7, Gursimran S Kochhar8. 1. Department of Gastroenterology and Hepatology, CHI Health Creighton University Medical Center Omaha. 2. Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT. 3. Gastroenterology and Hepatology, Lenox Hill Hospital, New York, NY. 4. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 5. Division of Pediatric Gastroenterology, Hepatology & Nutrition, University of Nebraska Medical Center, Omaha, NE. 6. Internal Medicine, Mayo Clinic, Rochester, MN. 7. Internal Medicine, Carilion Clinic, Roanoke, VA. 8. Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, PA.
Abstract
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.
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.
Authors: Edward L Barnes; Parakkal Deepak; Poonam Beniwal-Patel; Laura Raffals; Maia Kayal; Marla Dubinsky; Shannon Chang; Peter D R Higgins; Jennifer I Barr; Joseph Galanko; Yue Jiang; Raymond K Cross; Millie D Long; Hans H Herfarth Journal: Crohns Colitis 360 Date: 2022-08-02