Following total proctocolectomy with restorative ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC), about one-third of patients develop chronic pouchitis. Treatment of antibiotic-refractory and Crohn\u2019s disease-like pouchitis is challenging. A majority of these patients fail at least one or more anti-tumor necrosis factor (TNF) drug or biologic drug from another class before their colectomy. It is unclear whether reinitiating an anti-TNF drug in this case scenario would be beneficial. <\/p>\n\n\n\n
In this retrospective single-center study, 83 adult patients with IPAA who were taking a biologic drug for chronic antibiotic-refractory and\/or steroid-refractory pouchitis were evaluated and followed for a mean of 3 years. Among these patients, 53% used an anti-TNF for UC before colectomy, and all of them lost response to the therapy despite a therapeutic drug concentration and a lack of antibodies. Most patients used infliximab (81.8%), while a few received adalimumab (15.9%) or golimumab (2.23%). Over half also used an immunomodulator. <\/p>\n\n\n\n
For the chronic pouchitis, adalimumab was given to 43 (51.8%) patients, infliximab to 24 (28.9%), vedolizumab to 7 (8.4%), ustekinumab to 6 (7.2%), and certolizumab to 3 (3.6%). Patients who were treated with anti-TNF therapy precolectomy and postcolectomy were less likely to achieve clinical remission (adjusted odds ratio, 0.20; 95% confidence interval [CI], 0.06-0.61) and more likely to lose their pouch (odds ratio, 4.9; 95% CI, 1.34-18.13) compared to those who were biologic-na\u00efve preoperatively or exposed to a different biologic class postoperatively.<\/p>\n","protected":false},"excerpt":{"rendered":"
Following total proctocolectomy with restorative ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC), about one-third of patients develop chronic pouchitis. Treatment of antibiotic-refractory and Crohn\u2019s disease-like pouchitis is challenging. A majority of these patients fail at least one or more anti-tumor necrosis factor (TNF) drug or biologic drug from another class before their colectomy. It … Read more<\/a><\/p>\n","protected":false},"template":"","categories":[1768,1790],"tags":[1872,1875],"class_list":["post-8812","ec-news","type-ec-news","status-publish","hentry","category-asge-journal-scan","category-ibd","tag-anti-tnf","tag-ibd-2"],"_links":{"self":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news\/8812","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news"}],"about":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/types\/ec-news"}],"wp:attachment":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/media?parent=8812"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/categories?post=8812"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/tags?post=8812"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}