P0758 Efficacy of advanced therapies for the treatment of refractory pouchitis in patients with ileal-pouch anastomosis (IPAA): a multicentre Italian real-life experience

Abstract

Background: Total abdominal proctolectomy with ileal-pouch anastomosis (IPAA) for ulcerative colitis (UC) is associated with substantial complications, including the inflammation of the pouch, namely pouchitis. Its estimated cumulative probability is 80% in 30-year1 . The antibiotic therapy is highly effective2 ; however, up to 15-20% of patients develop chronic pouchitis (CP)3 . The aim of our study is to provide new evidence about effectiveness of biologic agents to treat CP. Method(s): We performed an observational retrospective multicentre study at five Italian IBD referral units including adult patients with IPAA for UC surgery treated with biologic/small molecule therapy due to CP. Primary aim was to evaluate clinical and endoscopic response at 6 and 12 months (defined as a reduction of clinical and endoscopic PDAI sub-scores by 2 points or more). Secondary aims were clinical remission (defined as clinical PDAI sub-score <3) at 6 and 12 months, endoscopic remission (defined as endoscopic PDAI sub-score <2) at 12 months and rate of treatment failure, defined as need for re-intervention or change of therapy. Rate of adverse events were calculated too. Result(s): 49 patients (pts), male 65.3%, mean age 47.4 +/- 14.8, 34 (75.6%) treated with advanced therapy before surgery (Table 1), were included and some of them has been treated with more than one advanced therapy after IPAA surgery and we used a total of 56 therapeutic lines for analyses. Amongst them, 28 pts (50%) reached clinical response at 6 months, whereas 22 (39.3%) at 12 months. Moreover, 41 (73.2%) pts achieved clinical remission at 6 months and 34 (60.7%) at 12 months. No statistical differences were found between each drug neither at 6 (p 0.471) nor at 12 months (p 0.38). However, anti-TNFalfa therapies and vedolizumab had higher rate of response compared to Ustekinumab (Table 2). Analyzing data about anti-TNFs, out of 8 pts with clinical and endoscopic response at 12 months, 5 failed at anti-TNFs before surgery. Therefore, 5 pts over 8 (62.5%) had a good answer to anti-TNFs even though they resulted failure before surgery. Only 1 patient was treated with JAKi (Tofacitinib). Endoscopic remission was achieved by 5/11 pts (45.5%) at 6 months and by 3/18 pts (16.7%) at 12 months. IPAA failure, with consequent ileostomy surgery was performed in just 2 pts, 1 at six months and 1 at 12 months. Adverse events occurred only in 1 pt (hitching). Conclusion(s): In our multicentre experience, clinical remission was achieved in 60.7% of patients with CP under advanced therapy. Anti-TNFs and vedolizumab in one-year therapy seemed to have similar efficacy rates. (Figure Presented).