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

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Abstract

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.

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Change history

  • 21 June 2021

    The first name and the family name of the fourth author, Salvatore F. Vadalà di Prampero has been corrected. The author name was published with the first name as ‘Salvatore F. Vadalà’ and the family name as ‘di Prampero’. The corrected first name is ‘Salvatore F.’ and the family name is ‘Vadalà di Prampero’.

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Acknowledgment

We would like to thank Dr. Barnes [25], Dr. Rubin [26], Dr. Teich [28], Dr. Peter [29], and Dr. Singh [30] for sharing additional unpublished data with us as available.

Funding

This work was not supported by any grants. No financial arrangements to disclose.

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Contributions

DS has received consulting fees from Abbott/AbbVie, Schering-Plough, MSD, Janssen Research & Development, LLC., Centocor Inc., TechLab, Hoffmann-LaRoche, Giuliani, Schering-Plough, and Ferring; research grants from AbbVie, Janssen Research & Development, LLC, Schering-Plough, TechLab, Centocor, Takeda and serves in the Speakers Bureau of AbbVie and the National Faculty of Janssen.

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Correspondence to Dario Sorrentino.

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The first name and the family name of the fourth author, Salvatore F. Vadalà di Prampero has been corrected. The author name was published with the first name as ‘Salvatore F. Vadalà’ and the family name as ‘di Prampero’. The corrected first name is ‘Salvatore F.’ and the family name is ‘Vadalà di Prampero’.

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Rocchi, C., Soliman, Y.Y., Massidda, M. et al. Is Ustekinumab Effective in Refractory Crohn’s Disease of the Pouch and Chronic Pouchitis? A Systematic Review. Dig Dis Sci 67, 1948–1955 (2022). https://doi.org/10.1007/s10620-021-07002-5

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