P0758 Efficacy of advanced therapies for the treatment of refractory pouchitis in patients with ileal-pouch anastomosis (IPAA): a multicentre Italian real-life experience
Authors: Carvalhas Gabrielli A M , Cannatelli R , Ferretti F , Carmagnola S , Savarino E V , Bertin L , Saibeni S , De Bernardi A , Ricci C , Zammarchi I , Ribaldone D G , De Vita F , Colombo F , Maconi G 
Published: January 2025

Abstract

Background
Total abdominal proctolectomy with ileal-pouch anastomosis (IPAA) for ulcerative colitis (UC) is associated with substantial complications, including the inflammation of the pouch, namely pouchitis. Its estimated cumulative probability is 80% in 30-year1. The antibiotic therapy is highly effective2; however, up to 15-20% of patients develop chronic pouchitis (CP)3. The aim of our study is to provide new evidence about effectiveness of biologic agents to treat CP.

Methods
We performed an observational retrospective multicentre study at five Italian IBD referral units including adult patients with IPAA for UC surgery treated with biologic/small molecule therapy due to CP. Primary aim was to evaluate clinical and endoscopic response at 6 and 12 months (defined as a reduction of clinical and endoscopic PDAI sub-scores by 2 points or more). Secondary aims were clinical remission (defined as clinical PDAI sub-score &lt;3) at 6 and 12 months, endoscopic remission (defined as endoscopic PDAI sub-score &lt;2) at 12 months and rate of treatment failure, defined as need for re-intervention or change of therapy. Rate of adverse events were calculated too.

Results
49 patients (pts), male 65.3%, mean age 47.4 ± 14.8, 34 (75.6%) treated with advanced therapy before surgery (Table 1), were included and some of them has been treated with more than one advanced therapy after IPAA surgery and we used a total of 56 therapeutic lines for analyses. Amongst them, 28 pts (50%) reached clinical response at 6 months, whereas 22 (39.3%) at 12 months. Moreover, 41 (73.2%) pts achieved clinical remission at 6 months and 34 (60.7%) at 12 months. No statistical differences were found between each drug neither at 6 (p 0.471) nor at 12 months (p 0.38). However, anti-TNFalfa therapies and vedolizumab had higher rate of response compared to Ustekinumab (Table 2). Analyzing data about anti-TNFs, out of 8 pts with clinical and endoscopic response at 12 months, 5 failed at anti-TNFs before surgery. Therefore, 5 pts over 8 (62.5%) had a good answer to anti-TNFs even though they resulted failure before surgery. Only 1 patient was treated with JAKi (Tofacitinib). Endoscopic remission was achieved by 5/11 pts (45.5%) at 6 months and by 3/18 pts (16.7%) at 12 months. IPAA failure, with consequent ileostomy surgery was performed in just 2 pts, 1 at six months and 1 at 12 months. Adverse events occurred only in 1 pt (hitching).

Conclusion
In our multicentre experience, clinical remission was achieved in 60.7% of patients with CP under advanced therapy. Anti-TNFs and vedolizumab in one-year therapy seemed to have similar efficacy rates.

References
1.Lightner AI, Mathis KI, Dozonis EJ, et al. Results up to 30 Years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Inflamm Bowel Dis. 2017;23(5);781-902. doi: 10.1097/MIB.0000000000001061.
2.Segal JP, Ding NS, Worley G, et al. Systematic review with meta-analysis: the management o chronic refractory pouchitis with an evidence-based treatment algorithm. Aliment Pharmacol Ther. 2017;45:581-923. doi: 10.1111/apt.13905.
3.Sandborn WJ. Pouchitis following ileal pouch-anal anastomosis: definition, pathogenesis, and treatment. Gastroenterology 1994;107:1856-60. doi: 10.1016/0016-5085(94)90832-x.