Biologics effective, safe for inflammatory conditions of the pouch

Use of biologics provides clinical benefits in patients with chronic, refractory inflammatory conditions of the pouch, with no new safety signals observed, reports a study. Moreover, infliximab appears more effective than adalimumab and vedolizumab for chronic antibiotic-refractory pouchitis (CARP).

A team of investigators did a literature search in major databases through 11 February 2020 for studies that examined the efficacy of biologics in CARP and Crohn’s disease (CD) of the pouch. Prospective and retrospective studies were both included. Variables were compared using the χ² test.

Thirty-four studies met the eligibility criteria. Of these, 16 (n=247) assessed infliximab use, which resulted in complete response in 50.7 percent and partial response in 28.1 percent of CARP patients, and complete response in 66.7 percent and partial response in 20.0 percent of CD patients.

Seven studies (n=107) assessing the use of adalimumab showed 33.3 percent of CARP patients achieving a complete response and 38.1 percent partial response, and 47.7 percent of CD patients attaining a complete response and 24.6 percent partial response.

In three studies (n=78) that examined ustekinumab, 50.0 percent had complete response and 3.8 percent had partial response for CARP. For CD of the pouch, 5.8 percent showed a complete response and 78.8 percent partial response.

Seven studies (n=151) also evaluated the efficacy of vedolizumab. For CARP, 28.4 percent and 43.2 percent of patients achieved complete and partial responses, respectively. On the other hand, 63.0 percent of CD patients had a partial response.

Treatment with infliximab resulted in higher rates of complete response in CARP compared with adalimumab (p=0.04) and vedolizumab (p=0.005), but not with ustekinumab (p=0.95). No new safety signals were reported in any of the eligible studies.

“Further prospective, head-to-head evaluations are needed to compare biological therapies in the treatment of CARP and CD of the pouch,” the investigators said.