Ustekinumab is effective for the treatment of crohn's disease of the pouch in a multicenter cohort

Kimberly N. Weaver, Martin Gregory, Gaurav Syal, Patrick Hoversten, Stephen Bradley Hicks, Devin Patel, George Christophi, Poonam Beniwal-Patel, Kim L. Isaacs, Laura E. H. Raffals, Parakkal Deepak, Hans H. Herfarth, Edward L. Barnes

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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. 10.1093/ibd/izx005-video1 izy302.video1 5844889626001

Original languageEnglish (US)
Pages (from-to)767-774
Number of pages8
JournalInflammatory bowel diseases
Volume25
Issue number4
DOIs
StatePublished - Mar 14 2019

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Pouchitis
Crohn Disease
Colonic Pouches
Tumor Necrosis Factor-alpha
Ulcerative Colitis
Therapeutics
Ustekinumab
Biological Products
Endoscopy
Multicenter Studies
Body Mass Index
Chronic Disease
Cohort Studies
Inflammation
Physicians
Population
vedolizumab

Keywords

  • CD of the pouch
  • mucosal healing
  • pouchitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Weaver, K. N., Gregory, M., Syal, G., Hoversten, P., Hicks, S. B., Patel, D., ... Barnes, E. L. (2019). Ustekinumab is effective for the treatment of crohn's disease of the pouch in a multicenter cohort. Inflammatory bowel diseases, 25(4), 767-774. https://doi.org/10.1093/ibd/izy302

Ustekinumab is effective for the treatment of crohn's disease of the pouch in a multicenter cohort. / Weaver, Kimberly N.; Gregory, Martin; Syal, Gaurav; Hoversten, Patrick; Hicks, Stephen Bradley; Patel, Devin; Christophi, George; Beniwal-Patel, Poonam; Isaacs, Kim L.; Raffals, Laura E. H.; Deepak, Parakkal; Herfarth, Hans H.; Barnes, Edward L.

In: Inflammatory bowel diseases, Vol. 25, No. 4, 14.03.2019, p. 767-774.

Research output: Contribution to journalArticle

Weaver, KN, Gregory, M, Syal, G, Hoversten, P, Hicks, SB, Patel, D, Christophi, G, Beniwal-Patel, P, Isaacs, KL, Raffals, LEH, Deepak, P, Herfarth, HH & Barnes, EL 2019, 'Ustekinumab is effective for the treatment of crohn's disease of the pouch in a multicenter cohort', Inflammatory bowel diseases, vol. 25, no. 4, pp. 767-774. https://doi.org/10.1093/ibd/izy302
Weaver, Kimberly N. ; Gregory, Martin ; Syal, Gaurav ; Hoversten, Patrick ; Hicks, Stephen Bradley ; Patel, Devin ; Christophi, George ; Beniwal-Patel, Poonam ; Isaacs, Kim L. ; Raffals, Laura E. H. ; Deepak, Parakkal ; Herfarth, Hans H. ; Barnes, Edward L. / Ustekinumab is effective for the treatment of crohn's disease of the pouch in a multicenter cohort. In: Inflammatory bowel diseases. 2019 ; Vol. 25, No. 4. pp. 767-774.
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abstract = "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-na{\"i}ve patients and those with prior anti-TNF or vedolizumab therapy failure. 10.1093/ibd/izx005-video1 izy302.video1 5844889626001",
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T1 - Ustekinumab is effective for the treatment of crohn's disease of the pouch in a multicenter cohort

AU - Weaver, Kimberly N.

AU - Gregory, Martin

AU - Syal, Gaurav

AU - Hoversten, Patrick

AU - Hicks, Stephen Bradley

AU - Patel, Devin

AU - Christophi, George

AU - Beniwal-Patel, Poonam

AU - Isaacs, Kim L.

AU - Raffals, Laura E. H.

AU - Deepak, Parakkal

AU - Herfarth, Hans H.

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N2 - 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. 10.1093/ibd/izx005-video1 izy302.video1 5844889626001

AB - 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. 10.1093/ibd/izx005-video1 izy302.video1 5844889626001

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