P340 Vedolizumab in the treatment of chronic refractory pouchitis: a systematic review
W-C. Lim*1, H. Lin1
1Tan Tock Seng Hospital, Department of Gastroenterology and Hepatology, Singapore, Singapore
Approximately 50% of patients with ileal pouch anal anastomosis (IPAA) develop pouchitis, with 10–15% of acute pouchitis developing chronic pouchitis (CP). Whilst the majority responds to antibiotic therapy, treatment options for chronic antibiotic-refractory pouchitis (CARP) include combination antibiotic therapy, budesonide, immunomodulators (IM) or anti-tumour necrosis factor (TNF) antibodies. There is limited data on the role of vedolizumab (VZB), an a4b7 integrin antagonist, in the treatment of CP. We performed a systematic review of the literature to explore the efficacy of VZB in CP.
A systematic literature search in MEDLINE (1966–November 2018), Cochrane Central Register of Clinical Trials, and abstracts from recent major gastroenterology meetings (Digestive Disease Week, United European Gastroenterology Week and Congress of European Crohn’s and Colitis Organisation) was performed using the following terms: ‘integrin’, ‘vedolizumab’, ‘pouchitis’. Only English language publications and abstracts on the efficacy of VZB for CP in ulcerative colitis patients with IPAA were included; Crohn’s disease of the pouch was excluded. Additional trials were identified through review of reference list of included articles
Six case reports (
From uncontrolled studies and case reports, VZB appears to be efficacious and safe for the treatment of CP refractory to antibiotics and other therapy including anti-TNF. Controlled data are needed to confirm its efficacy in this group of patients.
1. Martins D, Ministro P, Silva A, Refractory chronic pouchitis and autoimmune hemolytic anemia successfully treated with vedolizumab.
2. Orfanoudaki E, Foteinogiannopoulou K, Koutroubakis LE,. Use of vedolizimab in a patient with chronic and refractory pouchitis.
3. Coletta M, Paroni M, Caprioli F. Successful treatment with vedolizumab in a patient with chronic refractory pouchitis and primary sclerosing cholangitis, J Crohns Colitis , 1507–1508, 11
4. Mir F, Yousef MH, Partyka EK,
5. Bethege J, Meffert S, Ellrichmann M,
6. Schmid M, Frick JS, Malek N, et al. Successful treatment of pouchitis with vedolizumab, but no fecal microbiota transfer (FMT), after proctocolectomy in ulcerative colitis.
7. Philpott J, Ashburn J, Shen B. Efficacy of vedolizumab in patients with antibiotic and anti-tumor necrosis alpha refractory pouchitis.
8. Bar F, Kuhbacher T, Dietrich NA
9. Singh A, Khan F, Lopez R,
10. Verstockt B, Claeys C, Van Assche G,