Long-term outcomes of biologic therapy for the treatment of prepouch ileitis: A multi-centre multi-national...

Prepouch ileitis (PPI) is inflammation of the ileum proximal to an ileoanal pouch, usually associated with pouchitis. The treatment of PPI as a specific entity is poorly studied, and long-term follow-up data are lacking. We aimed to describe the long-term outcomes of biologic therapy in a large, multi-centre, multi-national cohort of patients with PPI.

This was an observational, retrospective, multi-centre, multi-national study. We included patients with an endoscopic diagnosis of PPI, treated with biologic medications, who had a follow-up of at least 1 year after biologic treatment initiation. The primary outcome was first-line biologic treatment discontinuation during the study period. The secondary outcome was pouch failure, defined by the need for a defunctioning ileostomy and/or pouch excision.

There were 71 patients in our cohort. Average follow-up length was 101.1 months (±54.5 months). Infliximab was first-line treatment in 42 patients (59.2%), whereas 26 (36.6%) initially received Adalimumab and 3 (4.2%) received Vedolizumab treatment. At the end of the study period, only 16/71 patients (22.5%) were still on first-line biologic treatment. Persistence rates for infliximab (7/42, 16.7%) and adalimumab (7/26, 26.9%) were similar (p = 0.30). Out of 55 patients discontinuing first-line biologic treatment, 26 (36.6% of the cohort) developed pouch failure, and 29 (40.8%) are currently treated with a different medication.

First-line biologic treatment for PPI is associated with high rates of treatment discontinuation. A significant proportion of PPI patients initially treated with biologics develop pouch failure.