P459 Vedolizumab for the treatment of chronic pouchitis: the Edinburgh experience
S. Cesano*1,2, G. R. Jones2, P. W. Jenkinson2, A. G. Shand2, C. W. Lees2, I. D. Arnott2, N. Plevris2
1University of Pavia, Pavia, Italy, 2The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
Pouchitis is the most common complication following ileal pouch-anal anastomosis (IPAA) formation for medically refractory UC. Despite most patients responding to antibiotics, 10–15% of patients will develop chronic debilitating pouchitis that becomes antibiotic dependant or refractory to antibiotics and immunosuppressive therapy. Vedolizumab is a gut selective a4b7 anti-integrin biologic that offers a potential new mechanism for the treatment of chronic pouchitis. Therefore, the aim of this study was to evaluate the effectiveness of vedolizumab for the treatment of chronic pouchitis
This was a retrospective case series performed at a tertiary IBD centre in Edinburgh, UK. All patients started on vedolizumab for the indication of antibiotic dependant or treatment refractory (failed antibiotic therapy ± immunomodulator or anti-TNF) pouchitis following IPAA for active UC were included. All patients had active pouchitis, defined by a pouchitis disease activity index (PDAI) >7. Baseline characteristics were collected via review of electronic medical records. Assessment of improvement was determined by the treating physician at last follow-up (score: ‘0’ no improvement; ‘1’ mild; ‘2’ moderate; ‘3’ excellent). Differences in the PDAI clinical subscore and faecal calprotectin levels between baseline and last follow-up were also analysed using the Wilcoxon signed rank test.
Seven patients were included (4 females, 3 males; median age 51 years [IQR 48–59]) with a median follow-up of 46 weeks (IQR 29–106). Of these, 6 patients were started on vedolizumab for the treatment of refractory pouchitis whilst 1 patient was started for antibiotic dependant disease. All patients remained on vedolizumab at the end of follow-up. Median PDAI at baseline was 9 (8–10). At last follow-up 0%, 42.9% (
Vedolizumab is an effective and well-tolerated treatment option for chronic refractory pouchitis.