Is Ustekinumab Effective in Refractory Crohn’s Disease of the Pouch and Chronic Pouchitis? A Systematic Review

• Published in: Digestive diseases and sciences Vol. 67; no. 6; pp. 1948 - 1955
• Main Authors: Rocchi, Chiara, Soliman, Youssef Y., Massidda, Marco, Vadalà di Prampero, Salvatore F., Bulajic, Milutin, Sorrentino, Dario
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2022; Springer; Springer Nature B.V
• Subjects: Adalimumab; Antibiotics; Biochemistry; Colitis; Colitis, Ulcerative - complications; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - surgery; Colonic Pouches; Crohn Disease - drug therapy; Crohn Disease - etiology; Crohn Disease - surgery; Crohns disease; Drug dosages; Drug therapy; Endoscopy; Fecal incontinence; Feces; Gastroenterology; Health aspects; Hepatology; Humans; Inflammatory bowel disease; Medical colleges; Medicine; Medicine & Public Health; Metronidazole; Monoclonal antibodies; Oncology; Pouchitis - diagnosis; Pouchitis - drug therapy; Pouchitis - etiology; Proctocolectomy, Restorative - adverse effects; Proteins; Remission (Medicine); Retrospective Studies; Review; Steroids; Systematic review; Transplant Surgery; Ustekinumab - therapeutic use; Ileal pouch anal anastomosis; Ustekinumab; Pouchitis; Crohn’s disease
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-021-07002-5

Crohn’s disease (CD) of the pouch and chronic pouchitis represent the most common long-term complications of total proctocolectomy and ileal pouch anal anastomosis (IPAA) for refractory ulcerative colitis (UC). These conditions are treated with multiple agents, including antibiotics, immunomodulators, and biologics. Among the latter, ustekinumab is approved for both CD and UC. We performed a systematic review to evaluate the efficacy of this anti-IL12/23 in CD of the pouch and chronic refractory pouchitis. Pubmed, Embase, Ovid, and the Cochrane Controlled Trials Register were searched to identify studies published until August 2020 investigating the use of ustekinumab for these conditions. Eighty-six eligible patients with IPAA—51 with CD of the pouch, 35 with chronic pouchitis—were identified from 2 retrospective studies and 5 case reports. Reported clinical response to ustekinumab was 63 and 85% in chronic pouchitis and CD of the pouch after 4–12 and 4–16 weeks, respectively. Clinical remission was reported in 10% of patients with chronic pouchitis and 27% of patients with CD of the pouch after 8–52 and 4–52 weeks of treatment, respectively. Endoscopic response was reported in 60% and 67% of patients with chronic pouchitis and CD of the pouch after 24–32 and 8–24 weeks of treatment respectively. Small sample sizes and large heterogeneity of therapy protocols/outcome definitions were significant studies limitations. In conclusion, there is a limited and inconclusive body of evidence suggesting that ustekinumab may be a therapeutic option for patients with chronic pouchitis and CD of the pouch refractory to other therapies.