Vedolizumab Is An Effective Treatment For Antibiotic Refractory Chronic Pouchitis

IntroductionVedolizumab is a gut selective monoclonal antibody to α4β7 integrin that can successfully treat IBD, currently licenced for the treatment of Ulcerative colitis and Crohn’s disease. Chronic pouchitis is the most common complication arising following proctocolectomy, affecting 15–50% of patients after ileo-anal pouch formation. To date there is little data regarding the use of vedolizumab in pouchitis. We aim to evaluate the efficacy and safety of vedolizumab in the treatment of chronic antibiotic refractory pouchitis.MethodsThis was a retrospective study that took place in the Edinburgh IBD unit between July 2015 and September 2019. Patients were included in the study who had confirmed chronic pouchitis and had failed to respond to antibiotic therapy with at least 6 months of follow up. We assessed clinical disease activity by completing the Pouchitis Activity Score clinical sub-score. We also assessed blood tests including CRP, faecal calprotectin and inflammatory activity on pouch biopsy. In our statistical analysis continuous variables were assessed with paired samples t tests, whilst changes in frequencies were asses with chi-squared tests. Adverse events were recorded quantitively.ResultsA total of 13 patients were included in the study. 6 females, median age 50 years (IQR 44.5–62). All patients underwent colectomy for failure of medical therapy. Following vedolizumab treatment, 92% of patients experienced a reduction in Pouchitis Activity Score clinical sub-score, with median score falling from 10 at baseline to 2.5 at follow up (p= <0.0001, IQR= 8–12 at baseline, 0–5 at follow up). Median faecal calprotectin fell from 390µg/g to 197µg/g at 1 year (p=0.02, IQR= 340–644 at baseline, 60–283 at follow up). Active inflammation levels on pouch biopsy decreased in 71% of participants ( Baseline- 4 mild, 1 moderate, 2 severe. Follow up- 3 mild, 4 none. Chi p= 0.0008. No serious adverse events were reported and only 15% of patients reported mild adverse events (1 arthropathy, 1 rhinitis).ConclusionsIn our cohort, vedolizumab is an effective and safe treatment for chronic antibiotic refractory pouchitis and produces improvements in symptoms, biochemical tests and histological inflammation. Whilst larger studies are needed, this is a treatment option for those who have failed conventional medical therapy.