Background: Little is known regarding the efficacy of ustekinumab in the treatment of pouchitis and Crohn’s Disease (CD) of the pouch in patients who are status post colectomy with ileal pouch-anal anastomosis (IPAA). Our aim was to evaluate the efficacy of ustekinumab in the treatment of CD of the pouch or chronic antibiotic dependent pouchitis (CADP) using a retrospective cohort of patients treated in a multidisciplinary inflammatory bowel disease (IBD) center. Methods: Clinical response to therapy was judged by the treating physician’s assessment at 12 and 26 weeks and Pouchitis Disease Activity Index (PDAI) endoscopy scores among patients undergoing follow up pouchoscopy. Demographics and clinical characteristics were compared among responders and non-responders to ustekinumab using Chi-Square, Fisher-Exact Test, Wilcoxon Rank Sum, and T-tests as appropriate. Results: A total of 23 patients with CADP (22%) or CD of the pouch (78%) were treated with ustekinumab. The majority of patients had received prior treatment with anti-tumor necrosis factor alpha (anti-TNF) therapy (83%, Table 1). Only 3 patients with CADP had completed 26 weeks of therapy at the time of analysis, with all patients demonstrating response. Among 15 patients with CD of the pouch, 14 (93%) demonstrated response to ustekinumab at 12 weeks and 13 (87%) demonstrated response at 26 weeks. At 12 weeks, the median C-reactive protein (CRP) among responders decreased by 14.0 g/dL compared to a change of +0.2 g/dL among the non-responders (p=0.504). Among responders at 26 weeks, the median PDAI change was -4.0 compared to -1.0 among non-responders (p=0.228, Table 2). Conclusion: In a retrospective cohort, ustekinumab appears to be effective in the treatment of CD of the pouch, as assessed by physician judgement as well as CRP and PDAI endoscopy scores. These results should be evaluated in a larger, prospective manner to judge the efficacy of ustekinumab in the treatment of CADP and CD of the pouch.
