- Fecal Incontinence
|Ustekinumab Is Effective for the Treatment of Crohn's Disease of the Pouch in a Multicenter Cohort
Weaver KN1, Gregory M2, Syal G3, Hoversten P4, Hicks SB4, Patel D5, Christophi G2,6, Beniwal-Patel P7, Isaacs KL1,8,9, Raffals L10, Deepak P2,6, Herfarth HH1,8,9, Barnes EL1,8. Inflamm Bowel Dis. 2018 Oct 5. doi: 10.1093/ibd/izy302. [Epub ahead of print]
1 Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
2 Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri.
3 Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California.
4 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
5 Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
6 Washington University Inflammatory Bowel Diseases Center, St. Louis, Missouri.
7 Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
8 Multidisciplinary Center for Inflammatory Bowel Diseases.
9 Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
10 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
BACKGROUND: Crohn's disease (CD) of the pouch and chronic pouchitis occur in approximately 10% of patients after ileal pouch-anal anastomosis (IPAA) for refractory ulcerative colitis (UC) or UC-related dysplasia. The efficacy of anti-tumor necrosis factor (anti-TNF) agents and vedolizumab have been reported for the treatment of CD of the pouch and chronic pouchitis, but little is known regarding the use of ustekinumab in these settings. Our primary aim was to evaluate the efficacy of ustekinumab for these conditions.
METHODS: This is a retrospective, multicenter cohort study evaluating the efficacy of ustekinumab in patients with CD of the pouch and chronic pouchitis. Clinical response or remission was judged by the treating physician's assessment at 6 months.
RESULTS: Fifty-six patients (47 with CD of the pouch and 9 with chronic pouchitis) were included the study. Of these, 73% had previously been treated with either anti-TNF therapy, vedolizumab, or both after IPAA. Among patients with CD of the pouch and chronic pouchitis, 83% demonstrated clinical response 6 months after induction with ustekinumab. Responders demonstrated significantly less pouch inflammation on endoscopy when compared with nonresponders (29% vs 100%; P = 0.023). Higher mean body mass index at induction (26.3 vs 23.7; P = 0.033) and male sex (83% vs 30%; P = 0.014) were significant predictors of nonresponse to ustekinumab in those with CD of the pouch.
CONCLUSION: In this refractory patient population, ustekinumab appears to be a safe and effective treatment for chronic pouchitis and CD of the pouch in biologic-naïve patients and those with prior anti-TNF or vedolizumab therapy failure.