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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

Background

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

Methods

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.

Results

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% (n = 3/7), 14.3% (n = 1/7) and 42.9% (n = 3/7) were deemed to have no, mild, moderate and excellent improvement, respectively. The mean PDAI clinical sub-score fell significantly from 5 to 2 (Figure 1A). The mean faecal calprotectin levels also fell significantly from 618 µg/g to 129 µg/g (Figure 1B). At last follow-up, 85.7% (n = 6/7) required no further antibiotic treatment since initiating vedolizumab including the patient with previously antibiotic dependant disease. Arthralgia was the only reported adverse event (n = 2).

Figure 1.

Conclusion

Vedolizumab is an effective and well-tolerated treatment option for chronic refractory pouchitis.