ArticleDigestive diseases and sciences2026
Comparative Effectiveness of Biologic Therapies in Chronic Pouchitis and Crohn's-Like Disease of the Pouch: A Bi-center Retrospective Cohort Study.
Article in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Review
- Managing Refractory Pouchitis: Which Biologic Is Best?Digestive diseases and sciences · 2026Article
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9 authors.
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Abstract
backgroundChronic pouchitis and Crohn's-like disease of the pouch are frequent complications following restorative total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). Biologics are increasingly used in refractory cases, but head-to-head comparative effectiveness data between biologic therapies are limited.
aimsWe aimed to compare week 52 clinical response and long-term treatment persistence among patients treated with vedolizumab, ustekinumab, or adalimumab.
methodsThis retrospective bi-center cohort study included adult patients with chronic pouchitis or Crohn's-like disease of the pouch with mPDAI ≥ 5 at biologic initiation. The primary endpoint was week 52 clinical response based on cPDAI, defined as a ≥ 1-point reduction from baseline. Key secondary endpoints were treatment persistence and week 52 mPDAI response (≥ 2-point reduction). Additional secondary endpoints included cPDAI remission, mPDAI remission, ePDAI response and remission, and biochemical outcomes. Between-group comparisons were performed using chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables, with post hoc pairwise comparisons adjusted for multiple testing. Treatment persistence was analyzed using Kaplan-Meier survival curves with log-rank test.
resultsSeventy-seven patients were included (vedolizumab n = 36; ustekinumab n = 22; adalimumab n = 19). Baseline characteristics including distribution of chronic pouchitis and Crohn's-like disease of the pouch were broadly comparable across groups, although ustekinumab was more frequently used as third-line therapy (p = 0.001). At week 52, cPDAI response occurred in 88.9% of patients treated with ustekinumab, 44.8% treated with vedolizumab, and 56.3% treated with adalimumab (p = 0.01). cPDAI remission was achieved in 33.3% of ustekinumab-treated patients, 13.8% of vedolizumab-treated patients, and 6.3% of adalimumab-treated patients (p = 0.09). No statistically significant differences were observed in biochemical remission across groups. Three-year treatment persistence was highest in the ustekinumab group (81.5%) compared with adalimumab (52%) and vedolizumab (35%) (p = 0.01).
conclusionsIn this real-world cohort, ustekinumab was associated with numerically higher long-term clinical response and treatment persistence compared with vedolizumab or adalimumab. These findings support the need for prospective trials to guide biologic selection in chronic pouchitis and Crohn's-like disease of the pouch.
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