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LONG TERM OUTCOMES OF FIRST LINE ANTI-TNF THERAPY FOR INFLAMMATORY POUCH CONDITIONS: A MULTI-NATIONAL STUDY

Itai Ghersin 1, Maya Fischman 2, Giacomo Calini 3, Eduard Koifman 4, Jonathan Segal 5, Orestis Argyriou 6, Valerio Celentano 7, Simon D. Mclaughlin 8, Heather Johnson 8, Matteo Rottoli 3, Kapil Sahnan 6, Janindra Warusavitarne 6, Ailsa L Hart 6

Affiliations

1 Rambam Health Care Campus, Haifa, Israel|||St. Mark's Hospital, London, United Kingdom

2 Hebrew University of Jerusalem, Jerusalem, Israel

3 IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy|||Alma Mater Studiorum University of Bologna, Bologna, Italy

4 Rambam Health Care Campus, Haifa, Israel

5 Royal Melbourne Hospital, Melbourne, Australia|||University of Melbourne, Parkville, Australia

6 St. Mark's Hospital, London, United Kingdom|||Imperial College London, London, United Kingdom

7 Imperial College London, London, United Kingdom|||Chelsea and Westminster Hospital, London, United Kingdom

8 The Royal Bournemouth Hospital, Bournemouth, United Kingdom

Summary

AI Generated

First-line anti-TNF therapy for chronic inflammatory pouch conditions shows low long-term persistence with only 14.9% of patients continuing treatment at median 101-month follow-up and 36.8% developing pouch failure.

In a retrospective multi-centre cohort of 87 patients with chronic inflammatory pouch conditions, median time to anti-TNF discontinuation was 12.2 months, with infliximab showing twice the hazard ratio for discontinuation compared to adalimumab.
The most common reason for stopping anti-TNF was lack of efficacy despite adequate drug levels (32.2%), followed by anti-drug antibody formation (20.7%) and side effects (13.8%).
Among 74 patients who discontinued first-line anti-TNF, 36.8% developed pouch failure requiring defunctioning ileostomy or pouch excision at median 38.6 months, while 48.3% transitioned to alternative medical therapies.
Combination therapy with immunomodulators did not significantly reduce treatment discontinuation rates compared to anti-TNF monotherapy.
This study provides long-term outcome data for a patient population where evidence has been limited to small studies without extended follow-up.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is one of the surgical options for patients with medically refractory ulcerative colitis (UC). It does, however, have long term complications, such as chronic idiopathic pouchitis, which develops in 10%–15% of patients with acute pouchitis.
Chronic inflammatory pouch conditions often require biologic treatment. Anti-tumour necrosis factor (anti-TNF) medications are commonly prescribed as first line biologic treatment for chronic inflammatory pouch conditions. However, their use in these conditions is based on studies of relatively small numbers of patients that lack long term follow up.

Aims & Methods

We aimed to describe the long term outcomes of first line anti-TNF therapy in a large, multi-centre multi-national cohort of patients with chronic inflammatory pouch conditions.
This was an observational retrospective study.
We included patients with chronic inflammatory pouch conditions initially treated with anti-TNF drugs infliximab (IFX) or Adalimumab (ADA), who had a follow up of at least 1 year.
The primary outcome was anti-TNF treatment persistence, defined as continuation of anti-TNF throughout the study period. Secondary outcome was pouch failure, defined by the need for a defunctioning ileostomy or pouch excision.

Results

We recruited 87 patients initially treated with anti-TNFs.
Average follow up length was 101 months.
The most common indication for biologic treatment was chronic pouchitis with concomitant pre-pouch ileitis (62/87 patients, 71.3%). Chronic pouchitis without pre-pouch ileitis was the treatment indication in 19 patients (21.8%). Pre-pouch ileitis, without concomitant pouchitis, was seen in 7 patients (6.9%).
IFX was the most common first line anti-TNF treatment (55/87 patients, 63.2%), while 32 patients (36.8%) were treated with first line ADA.
Anti-TNF was administered as monotherapy in 46 patients, while 27 patients received it in combination with an immunomodulator.
Second line treatments included IFX (6 patients), ADA (15 patients), Vedolizumab (16 patients), Ustekinumab (12 patients) and Upadacitinib (one patient).
At the end of the study period only 13/87 patients (14.9%) were still on first line anti-TNF treatment.
The median time to anti-TNF discontinuation was 12.2 months.
The most common cause for anti-TNF discontinuation was lack of efficacy despite adequate serum drug levels and absence of anti-drug antibody formation (28 patients, 32.2%). Loss of response due to anti-drug antibody formation was the cause in 18 patients (20.7%), while 12 patients (13.8%) stopped treatment because of side effects/safety concerns.
Compared to patients receiving ADA, patients receiving IFX had an HR of 2.0 for treatment discontinuation (p=0.016).
Compared to patients receiving combination therapy of anti TNFs with immunomodulators, patients receiving anti-TNF monotherapy had similar rates of treatment discontinuation (p=0.155).
Out of the 74 patients who discontinued first line anti-TNF treatment, 42 (48.3%) are currently treated with a different medical therapy, and 32 (36.8%) developed pouch failure.
The median time to pouch failure was 38.6 months.
Patients receiving IFX were not at increased risk of pouch failure compared to those receiving ADA (p=0.2).

Conclusion

First line anti-TNF therapy for chronic pouch inflammatory conditions is associated with low long term persistence rates.
A significant proportion of patients initially treated with anti-TNF therapy develop pouch failure.

These patients should be counselled about the high risk of pouch failure.

Conference

UEG Week Berlin 2025

Topics

IBD

Submission format

Abstract

Session

Perianal Crohn's disease and pouchitis (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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BURNOUT SYNDROME ASSESSMENT OF NURSING STAFF IN A DIGESTIVE ENDOSCOPY UNIT AT A TERTIARY REFERRAL HOSPITAL

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