Efficacy of Vedolizumab for Refractory Pouchitis of the Ileo-anal Pouch: Results From a Multicenter US Cohort

Martin Gregory, Kimberly N. Weaver, Patrick Hoversten, Stephen Bradley Hicks, Devin Patel, Matthew A. Ciorba, Alexandra M. Gutierrez, Poonam Beniwal-Patel, Sowmya Palam, Gaurav Syal, Hans H. Herfarth, George Christophi, Laura E. H. Raffals, Edward L. Barnes, Parakkal Deepak

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND AND AIMS: Inflammation of the pouch after ileal pouch-anal anastomosis (IPAA) can significantly impact quality of life and be difficult to treat. We assessed the effectiveness and safety of vedolizumab in Crohn's disease (CD) of the pouch and chronic antibiotic-dependent or antibiotic-refractory pouchitis. METHODS: This was a retrospective, multicenter cohort study at 5 academic referral centers in the United States. Adult patients with endoscopic inflammation of the pouch who received vedolizumab were included. The primary outcome was clinical response at any time point. Secondary outcomes included clinical remission, endoscopic response, and remission. Univariate analysis and multivariate analysis were performed for the effect of the following variables on clinical response: fistula, onset of pouchitis less than 1 year after IPAA, younger than 35 years old, gender, previous tumor necrosis factor inhibitor-alpha use, and BMI >30. RESULTS: Eighty-three patients were treated with vedolizumab for inflammation of the pouch between January 2014 and October 2017. Median follow-up was 1.3 years (interquartile range 0.7-2.1). The proportion of patients that achieved at least a clinical response was 71.1%, with 19.3% achieving clinical remission. Of the 74 patients with a follow-up pouchoscopy, the proportion of patients with endoscopic response and mucosal healing was 54.1% and 17.6%, respectively. Patients who developed pouchitis symptoms less than 1 year after undergoing IPAA were less likely to respond to vedolizumab, even after controlling for other risk factors. CONCLUSIONS: Vedolizumab is safe and effective in the management of CD of the pouch and chronic pouchitis. Further studies are needed to compare vedolizumab with other biologic therapies for pouchitis and CD of the pouch.

Original languageEnglish (US)
Pages (from-to)1569-1576
Number of pages8
JournalInflammatory bowel diseases
Volume25
Issue number9
DOIs
StatePublished - Aug 20 2019

Fingerprint

Pouchitis
Colonic Pouches
Crohn Disease
Inflammation
Anti-Bacterial Agents
Biological Therapy
Multicenter Studies
Fistula
vedolizumab
Cohort Studies
Referral and Consultation
Multivariate Analysis
Tumor Necrosis Factor-alpha
Quality of Life
Safety

Keywords

  • Crohn’s disease
  • pouchitis
  • vedolizumab

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Gregory, M., Weaver, K. N., Hoversten, P., Hicks, S. B., Patel, D., Ciorba, M. A., ... Deepak, P. (2019). Efficacy of Vedolizumab for Refractory Pouchitis of the Ileo-anal Pouch: Results From a Multicenter US Cohort. Inflammatory bowel diseases, 25(9), 1569-1576. https://doi.org/10.1093/ibd/izz030

Efficacy of Vedolizumab for Refractory Pouchitis of the Ileo-anal Pouch : Results From a Multicenter US Cohort. / Gregory, Martin; Weaver, Kimberly N.; Hoversten, Patrick; Hicks, Stephen Bradley; Patel, Devin; Ciorba, Matthew A.; Gutierrez, Alexandra M.; Beniwal-Patel, Poonam; Palam, Sowmya; Syal, Gaurav; Herfarth, Hans H.; Christophi, George; Raffals, Laura E. H.; Barnes, Edward L.; Deepak, Parakkal.

In: Inflammatory bowel diseases, Vol. 25, No. 9, 20.08.2019, p. 1569-1576.

Research output: Contribution to journalArticle

Gregory, M, Weaver, KN, Hoversten, P, Hicks, SB, Patel, D, Ciorba, MA, Gutierrez, AM, Beniwal-Patel, P, Palam, S, Syal, G, Herfarth, HH, Christophi, G, Raffals, LEH, Barnes, EL & Deepak, P 2019, 'Efficacy of Vedolizumab for Refractory Pouchitis of the Ileo-anal Pouch: Results From a Multicenter US Cohort', Inflammatory bowel diseases, vol. 25, no. 9, pp. 1569-1576. https://doi.org/10.1093/ibd/izz030
Gregory, Martin ; Weaver, Kimberly N. ; Hoversten, Patrick ; Hicks, Stephen Bradley ; Patel, Devin ; Ciorba, Matthew A. ; Gutierrez, Alexandra M. ; Beniwal-Patel, Poonam ; Palam, Sowmya ; Syal, Gaurav ; Herfarth, Hans H. ; Christophi, George ; Raffals, Laura E. H. ; Barnes, Edward L. ; Deepak, Parakkal. / Efficacy of Vedolizumab for Refractory Pouchitis of the Ileo-anal Pouch : Results From a Multicenter US Cohort. In: Inflammatory bowel diseases. 2019 ; Vol. 25, No. 9. pp. 1569-1576.
@article{cd93cd4e317f4bce82a72011cf059abe,
title = "Efficacy of Vedolizumab for Refractory Pouchitis of the Ileo-anal Pouch: Results From a Multicenter US Cohort",
abstract = "BACKGROUND AND AIMS: Inflammation of the pouch after ileal pouch-anal anastomosis (IPAA) can significantly impact quality of life and be difficult to treat. We assessed the effectiveness and safety of vedolizumab in Crohn's disease (CD) of the pouch and chronic antibiotic-dependent or antibiotic-refractory pouchitis. METHODS: This was a retrospective, multicenter cohort study at 5 academic referral centers in the United States. Adult patients with endoscopic inflammation of the pouch who received vedolizumab were included. The primary outcome was clinical response at any time point. Secondary outcomes included clinical remission, endoscopic response, and remission. Univariate analysis and multivariate analysis were performed for the effect of the following variables on clinical response: fistula, onset of pouchitis less than 1 year after IPAA, younger than 35 years old, gender, previous tumor necrosis factor inhibitor-alpha use, and BMI >30. RESULTS: Eighty-three patients were treated with vedolizumab for inflammation of the pouch between January 2014 and October 2017. Median follow-up was 1.3 years (interquartile range 0.7-2.1). The proportion of patients that achieved at least a clinical response was 71.1{\%}, with 19.3{\%} achieving clinical remission. Of the 74 patients with a follow-up pouchoscopy, the proportion of patients with endoscopic response and mucosal healing was 54.1{\%} and 17.6{\%}, respectively. Patients who developed pouchitis symptoms less than 1 year after undergoing IPAA were less likely to respond to vedolizumab, even after controlling for other risk factors. CONCLUSIONS: Vedolizumab is safe and effective in the management of CD of the pouch and chronic pouchitis. Further studies are needed to compare vedolizumab with other biologic therapies for pouchitis and CD of the pouch.",
keywords = "Crohn’s disease, pouchitis, vedolizumab",
author = "Martin Gregory and Weaver, {Kimberly N.} and Patrick Hoversten and Hicks, {Stephen Bradley} and Devin Patel and Ciorba, {Matthew A.} and Gutierrez, {Alexandra M.} and Poonam Beniwal-Patel and Sowmya Palam and Gaurav Syal and Herfarth, {Hans H.} and George Christophi and Raffals, {Laura E. H.} and Barnes, {Edward L.} and Parakkal Deepak",
year = "2019",
month = "8",
day = "20",
doi = "10.1093/ibd/izz030",
language = "English (US)",
volume = "25",
pages = "1569--1576",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "John Wiley and Sons Inc.",
number = "9",

}

TY - JOUR

T1 - Efficacy of Vedolizumab for Refractory Pouchitis of the Ileo-anal Pouch

T2 - Results From a Multicenter US Cohort

AU - Gregory, Martin

AU - Weaver, Kimberly N.

AU - Hoversten, Patrick

AU - Hicks, Stephen Bradley

AU - Patel, Devin

AU - Ciorba, Matthew A.

AU - Gutierrez, Alexandra M.

AU - Beniwal-Patel, Poonam

AU - Palam, Sowmya

AU - Syal, Gaurav

AU - Herfarth, Hans H.

AU - Christophi, George

AU - Raffals, Laura E. H.

AU - Barnes, Edward L.

AU - Deepak, Parakkal

PY - 2019/8/20

Y1 - 2019/8/20

N2 - BACKGROUND AND AIMS: Inflammation of the pouch after ileal pouch-anal anastomosis (IPAA) can significantly impact quality of life and be difficult to treat. We assessed the effectiveness and safety of vedolizumab in Crohn's disease (CD) of the pouch and chronic antibiotic-dependent or antibiotic-refractory pouchitis. METHODS: This was a retrospective, multicenter cohort study at 5 academic referral centers in the United States. Adult patients with endoscopic inflammation of the pouch who received vedolizumab were included. The primary outcome was clinical response at any time point. Secondary outcomes included clinical remission, endoscopic response, and remission. Univariate analysis and multivariate analysis were performed for the effect of the following variables on clinical response: fistula, onset of pouchitis less than 1 year after IPAA, younger than 35 years old, gender, previous tumor necrosis factor inhibitor-alpha use, and BMI >30. RESULTS: Eighty-three patients were treated with vedolizumab for inflammation of the pouch between January 2014 and October 2017. Median follow-up was 1.3 years (interquartile range 0.7-2.1). The proportion of patients that achieved at least a clinical response was 71.1%, with 19.3% achieving clinical remission. Of the 74 patients with a follow-up pouchoscopy, the proportion of patients with endoscopic response and mucosal healing was 54.1% and 17.6%, respectively. Patients who developed pouchitis symptoms less than 1 year after undergoing IPAA were less likely to respond to vedolizumab, even after controlling for other risk factors. CONCLUSIONS: Vedolizumab is safe and effective in the management of CD of the pouch and chronic pouchitis. Further studies are needed to compare vedolizumab with other biologic therapies for pouchitis and CD of the pouch.

AB - BACKGROUND AND AIMS: Inflammation of the pouch after ileal pouch-anal anastomosis (IPAA) can significantly impact quality of life and be difficult to treat. We assessed the effectiveness and safety of vedolizumab in Crohn's disease (CD) of the pouch and chronic antibiotic-dependent or antibiotic-refractory pouchitis. METHODS: This was a retrospective, multicenter cohort study at 5 academic referral centers in the United States. Adult patients with endoscopic inflammation of the pouch who received vedolizumab were included. The primary outcome was clinical response at any time point. Secondary outcomes included clinical remission, endoscopic response, and remission. Univariate analysis and multivariate analysis were performed for the effect of the following variables on clinical response: fistula, onset of pouchitis less than 1 year after IPAA, younger than 35 years old, gender, previous tumor necrosis factor inhibitor-alpha use, and BMI >30. RESULTS: Eighty-three patients were treated with vedolizumab for inflammation of the pouch between January 2014 and October 2017. Median follow-up was 1.3 years (interquartile range 0.7-2.1). The proportion of patients that achieved at least a clinical response was 71.1%, with 19.3% achieving clinical remission. Of the 74 patients with a follow-up pouchoscopy, the proportion of patients with endoscopic response and mucosal healing was 54.1% and 17.6%, respectively. Patients who developed pouchitis symptoms less than 1 year after undergoing IPAA were less likely to respond to vedolizumab, even after controlling for other risk factors. CONCLUSIONS: Vedolizumab is safe and effective in the management of CD of the pouch and chronic pouchitis. Further studies are needed to compare vedolizumab with other biologic therapies for pouchitis and CD of the pouch.

KW - Crohn’s disease

KW - pouchitis

KW - vedolizumab

UR - http://www.scopus.com/inward/record.url?scp=85071604896&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071604896&partnerID=8YFLogxK

U2 - 10.1093/ibd/izz030

DO - 10.1093/ibd/izz030

M3 - Article

C2 - 30810748

AN - SCOPUS:85071604896

VL - 25

SP - 1569

EP - 1576

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 9

ER -