Biologic Therapies for the Treatment of Post Ileal Pouch Anal Anastomosis Surgery Chronic Inflammatory Disorders: Systematic Review and Meta-analysis

BackgroundChronic inflammatory disorders after ileal pouch-anal anastomosis (IPAA) surgery are common. These include chronic pouchitis, Crohns disease of the pouch, prepouch ileitis, and rectal cuff inflammation. The aim of this study was to evaluate the efficacy of biologic therapies in treating these disorders. MethodSystematic review of all published studies from inception to April 1st, 2021 was performed to investigate the efficacy of biologic therapies for post IPAA chronic inflammatory disorders. The primary outcome was the efficacy of biologic therapies in achieving complete response or remission. A subgroup analysis was performed for each disorder separately. ResultsA total of 24 studies were identified including 682 patients. Using a random effect model, the overall pooled efficacy of biologic therapies in achieving complete response or remission in patients with post IPAA surgery chronic inflammatory disorders was 60% (95% Confidence Interval (CI), 56 - 64). Specifically, the pooled efficacy of ustekinumab was 75% (95% CI, 64 - 85, p = 0.007), whereas the efficacy of vedolizumab was 60% (95% CI, 52 - 68, p = 0.172). In addition, the efficacy infliximab and adalimumab were 59% (95% CI, 53 - 64, p <0.01) and 51% (95% CI, 42 - 60, p = 0.452) respectively. ConclusionUstekinumab, infliximab, vedolizumab and adalimumab are effective in achieving complete response or remission in post IPAA surgery chronic inflammatory disorders. There is also a clear trend toward higher efficacy in patients with Crohns disease of the pouch compared to chronic pouchitis. More studies are needed to determine the efficacy of biologics in cuffitis. SummaryChronic inflammatory disorders after ileal pouch-anal anastomosis surgery are common. These include chronic pouchitis, Crohns disease of the pouch, prepouch ileitis, and rectal cuff inflammation. This study aimed to evaluate the efficacy of biologic therapies in achieving complete response or remission in these disorders.