Outcomes of Standard and Intensified Dosing of Ustekinumab for Chronic Pouch Disorders

Up to 10% of patients with ulcerative colitis (UC) require total proctocolectomy (TPC) within 10 years after diagnosis.1 Ileal pouch-anal anastomosis (IPAA) is the preferred operation in this population. However, chronic pouch disorders (CPDs), including chronic antibiotic-refractory pouchitis (CARP) and Crohn’s disease of the pouch (CDoP), may occur in up to 30% and 10% of patients after IPAA, respectively.2 Patients with refractory CPDs often require biologic therapy or pouch excision.3 Ustekinumab (UST) is an anti-interleukin therapy approved for UC and CD. Limited data from small cohorts suggest that every 8 week (q8w) dosing of UST effectively treats CPDs.4,5 However, patients with CPDs may lose response to q8w dosing. Dose intensification to every 4 weeks (q4w) or every 6 weeks (q6w) appears to be effective among CD patients who lose response to UST, however similar data does not exist for CPDs.6 We therefore sought...