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P693 Vedolizumab treatment for pouch inflammation

A. Hirsch*1, H. Tulchinsky2, N. Maharshak1

1Tel Aviv Medical Center, Gastroenterology and liver diseases, Tel Aviv, Israel, 2Tel Aviv Medical Center, Department of Surgery, Tel Aviv, Israel

Background

Pouchitis is the most common complication in UC patients following total proctocolectomy with ileal pouch anal anastomosis surgery, with a reported cumulative prevalence ranging from 23% to 46%. Oral antibiotic therapy is the mainstay treatment, however, 10–15% of patients with pouchitis develop chronic antibiotic-dependent/refractory pouchitis or Crohn’s-like disease of the pouch (CLDP) requiring treatment escalation to immuno-modulatory or biologic therapy. Our aim was to evaluate the safety and efficacy of vedolizumab in patients with antibiotic-dependent/refractory pouchitis.

Methods

We performed a retrospective chart review of patients with chronic antibiotic-dependent or refractory pouchitis who were treated with vedolizumab (300 mg at week 0, 2, 6 and 14) and were followed at the Tel Aviv Medical Center. Data collected included demographics, Pre and post-pouch therapy, modified pouch disease activity index (mPDAI) and serum C-reactive protein (CRP). The effectiveness of vedolizumab treatment was based on mPDAI and CRP level at Weeks 14 and 22.

Results

We identified 10 patients (7 males, median age 58 years) after IPAA with chronic antibiotic-dependent or refractory pouchitis, who were treated with vedolizumab; their baseline characteristics shown in Table 1. Of these patients, 7 had concomitant pre-pouch ileal inflammation and 3 had cuffitis. Six of these patients were previously treated with TNF-inhibitors for their pouch inflammation. The mean mPDAI dropped from 6.7 (range 5–10) to 3.6 (range 2–7), this was statistically significant (p = 0.05), as shown in Table 2 and graph 1. CRP levels remained stable throughout Week 22 (mean 9.85, range 2.1–20.7). No serious side effects were recorded, and all patients were off antibiotic therapy.

Conclusion

Vedolizumab is both safe and effective in patients with antibiotic-dependent/refractory pouchitis, and in patients with concomitant pre-pouch ileitis.