Advanced Therapy May Reduce Antibiotic Dependence in Chronic Pouchitis After IPAA
Nearly half of patients with chronic pouchitis experienced reduced antibiotic use after initiating advanced therapy (AT), according to a multicenter retrospective study examining real-world treatment patterns following ileal pouch–anal anastomosis (IPAA) for ulcerative colitis (UC). The findings address an important unmet need in managing antibiotic dependence in this population.
Chronic pouchitis affects approximately one-quarter of patients after total proctocolectomy with IPAA and often necessitates frequent or prolonged antibiotic exposure. While immune-targeted advanced therapies are increasingly used, their impact on antibiotic requirements has not been well defined. To address this gap, investigators evaluated adults with UC and endoscopically confirmed pouchitis who initiated AT, excluding those with Crohn’s-like disease of the pouch or isolated cuffitis.
The incidence cohort included 58 patients newly starting AT, with at least one year of follow-up. Therapies included tumor necrosis factor antagonists, vedolizumab, and ustekinumab. Over follow-up, 59% of patients experienced a reduction in the proportion of time spent on antibiotics, while 41% had no reduction or increased use. Among those with reduced antibiotic exposure, the absolute decrease averaged 20% of follow-up time.
Notably, ustekinumab use was more common in patients who reduced antibiotic use compared with those who did not (38% vs 8%). This association remained significant in multivariable analysis. Other clinical factors, including history of primary sclerosing cholangitis, age at UC diagnosis, or time from IPAA creation to AT initiation, were not predictive of reduced antibiotic use.
The authors reported that “almost half of patients who were started on AT for chronic pouchitis had a reduction in antibiotic use over the first 1–2 years of treatment.” However, they emphasized that “disease-related parameters did not predict which patients may experience this reduction,” highlighting the need for better predictors of response.
Reference
Pan Y, Dunleavy K, Ananthakrishnan A. Impact of advanced therapy initiation on antibiotic dependence in chronic pouchitis. Inflammatory Bowel Diseases. 2026;32(Supplement_1). https://doi.org/10.1093/ibd/izag006.050
