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Ustekinumab Is Effective for the Treatment of Chronic Antibiotic-Refractory Pouchitis

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Abstract

Background

Chronic antibiotic-refractory pouchitis (CARP) occurs in up to 15% of patients with ulcerative colitis (UC) following proctocolectomy with ileal pouch–anal anastomosis (IPAA).

Aim

To investigate the effectiveness of ustekinumab in the treatment of CARP.

Methods

This was a retrospective single-center study of UC patients with an IPAA, who subsequently developed CARP and received ustekinumab with standard Crohn’s disease (CD) dosing between 2016 and 2018. Patients with CD of the pouch were excluded. Demographic, clinical, and endoscopic data were collected. Outcomes included a change in the endoscopic subscore of the Pouchitis Disease Activity Index (PDAI), change in the ulcerated surface area, clinical response, and the number of bowel movements per 24 h.

Results

Twenty-four patients with CARP were included for analysis. Median follow-up time was 12.9 months (IQR 7.9-16). Twelve patients (50%) had a clinical response with the median number of bowel movements within 24 h decreasing from 8 (IQR, 5–12) to 6 (IQR, 5–8) P = 0.002. Thirteen patients had pouchoscopies available post-ustekinumab treatment. In these patients, the median endoscopic subscore of the PDAI decreased from 5 (IQR, 3–6) to 4 (IQR, 2–5), P = 0.016. Likewise, among these thirteen patients, nine (69%) had an ulcerated surface area > 10% before ustekinumab treatment; after treatment with ustekinumab, only four patients (31%) still had an ulcerated surface area of > 10%.

Conclusions

This is the largest study of ustekinumab treatment for patients with chronic antibiotic-refractory pouchitis. We found that ustekinumab therapy led to the improvement in clinical and endoscopic endpoints.

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References

  1. Targownik LE, Singh H, Nugent Z, Bernstein CN. The epidemiology of colectomy in ulcerative colitis: results from a population-based cohort. Am J Gastroenterol. 2012;107:1228–1235. https://doi.org/10.1038/ajg.2012.127.

    Article  PubMed  Google Scholar 

  2. Solberg IC, Lygren I, Jahnsen J, et al. Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study). Scand J Gastroenterol. 2009;44:431–440. https://doi.org/10.1080/00365520802600961.

    Article  PubMed  Google Scholar 

  3. Mahadevan U, Sandborn WJ. Diagnosis and management of pouchitis. Gastroenterology. 2003;124:1636–1650. Epub 2003/05/23 PubMed PMID: 12761722.

    Article  Google Scholar 

  4. Barnes EL, Herfarth HH, Sandler RS, et al. Pouch-Related Symptoms and Quality of Life in Patients with Ileal Pouch-Anal Anastomosis. Inflamm Bowel Dis. 2017;23:1218–1224. https://doi.org/10.1097/mib.0000000000001119.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Heuschen UA, Allemeyer EH, Hinz U, et al. Diagnosing pouchitis: comparative validation of two scoring systems in routine follow-up. Dis Colon Rectum. 2002;45:776–786. discussion 86–88.

    Article  Google Scholar 

  6. Yamamoto T, Shimoyama T, Bamba T, Matsumoto K. Consecutive Monitoring of Fecal Calprotectin and Lactoferrin for the Early Diagnosis and Prediction of Pouchitis after Restorative Proctocolectomy for Ulcerative Colitis. Am J Gastroenterol. 2015;110:881–887. https://doi.org/10.1038/ajg.2015.129.

    Article  CAS  PubMed  Google Scholar 

  7. Magro F, Gionchetti P, Eliakim R, et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis. 2017;11:649–670. https://doi.org/10.1093/ecco-jcc/jjx008.

    Article  PubMed  Google Scholar 

  8. Dalal RL, Shen B, Schwartz DA. Management of Pouchitis and Other Common Complications of the Pouch. Inflamm Bowel Dis. 2018;24:989–996. https://doi.org/10.1093/ibd/izy020.

    Article  PubMed  Google Scholar 

  9. Bar F, Kuhbacher T, Dietrich NA, et al. Vedolizumab in the treatment of chronic, antibiotic-dependent or refractory pouchitis. Aliment Pharmacol Ther. 2018;47:581–587. https://doi.org/10.1111/apt.14479.

    Article  CAS  PubMed  Google Scholar 

  10. Feagan BG, Sandborn WJ, Gasink C, et al. Ustekinumab as Induction and Maintenance Therapy for Crohn’s Disease. N Engl J Med. 2016;375:1946–1960. https://doi.org/10.1056/nejmoa1602773.

    Article  CAS  PubMed  Google Scholar 

  11. Sandborn WJ, Tremaine WJ, Batts KP, Pemberton JH, Phillips SF. Pouchitis after ileal pouch-anal anastomosis: a Pouchitis Disease Activity Index. Mayo Clin Proc. 1994;69:409–415. Epub 1994/05/01 PubMed PMID: 8170189.

    Article  CAS  Google Scholar 

  12. Weaver KN, Gregory M, Syal G, et al. Ustekinumab Is Effective for the Treatment of Crohn’s Disease of the Pouch in a Multicenter Cohort. Inflamm Bowel Dis. 2018;. https://doi.org/10.1093/ibd/izy302.

    Article  Google Scholar 

  13. Samaan MA, Shen B, Mosli MH, et al. Reliability among central readers in the evaluation of endoscopic disease activity in pouchitis. Gastrointest Endosc. 2018;88:360–369 e2. https://doi.org/10.1016/j.gie.2018.04.2330.

    Article  PubMed  Google Scholar 

  14. Huguet M, Pereira B, Goutte M, et al. Systematic Review With Meta-Analysis: Anti-TNF Therapy in Refractory Pouchitis and Crohn’s Disease-Like Complications of the Pouch After Ileal Pouch-Anal Anastomosis Following Colectomy for Ulcerative Colitis. Inflamm Bowel Dis. 2018;24:261–268. https://doi.org/10.1093/ibd/izx049.

    Article  PubMed  Google Scholar 

  15. Sands BE, Sandborn WJ, Panaccione R, O’Brien CD, Zhang H, Johanns J, Peyrin-Biroulet L, Van-Assche G, Danese S, Targan S, Abreu MT, Hisamatsu T, Szapary P, Marano C. Safety and Efficacy of Ustekinumab Induction Therapy in Patients with Moderate to Severe Ulcerative Colitis: Results from the Phase 3 UNIFI Study. Presented at ACG 2018.

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Funding

This work received no outside funding.

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Authors and Affiliations

  1. University of Chicago Medicine, Inflammatory Bowel Disease Center, 5841 S. Maryland Ave, MC 4076, Chicago, IL, 60637, USA

    Jacob E. Ollech, David T. Rubin, Laura Glick, Roni Weisshof, Katia El Jurdi, Amanda Israel, Noa Krugliak Cleveland, Neil Hyman, Atsushi Sakuraba, Joel Pekow, Russell D. Cohen & Sushila R. Dalal

Authors
  1. Jacob E. Ollech
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  2. David T. Rubin
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  3. Laura Glick
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  4. Roni Weisshof
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  5. Katia El Jurdi
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  6. Amanda Israel
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  7. Noa Krugliak Cleveland
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  9. Atsushi Sakuraba
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  10. Joel Pekow
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  11. Russell D. Cohen
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  12. Sushila R. Dalal
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Contributions

JEO, DTR, and SRD conceived and designed the study. JEO, LG, RW, AI, KEJ, and NCK contributed to the acquisition of data. JEO, DTR, SRD, RW, RDC, AS, JP, and NH contributed to the analysis and interpretation of data. All authors were involved in drafting the article or revising it critically for important intellectual content. All authors approved the final manuscript to be submitted.

Corresponding author

Correspondence to David T. Rubin.

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Conflict of interest

JEO, RW, KEJ, AI, NKC, and NH have no relevant disclosures. DTR is a consultant and has received grant support from Abbvie, Merck & Co., Janssen, Takeda, and Pfizer. AS has received funding from AbbVie, Celltrion, and Takeda. JP has received grants from Takeda and Abbvie and serves as a consultant for Verastem. He was on the advisory board for Pfizer and Janssen. RDC is a consultant at Abbvie, Celgene, Janssen, Pfizer, Takeda, and UCB Pharma. SD has received grant support from Pfizer. No funding or sponsorship was received for this study or publication of this article.

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Ollech, J.E., Rubin, D.T., Glick, L. et al. Ustekinumab Is Effective for the Treatment of Chronic Antibiotic-Refractory Pouchitis. Dig Dis Sci 64, 3596–3601 (2019). https://doi.org/10.1007/s10620-019-05697-1

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  • DOI: https://doi.org/10.1007/s10620-019-05697-1

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