{Reference Type}: Journal Article
{Title}: Treatment of Antibiotic Refractory Chronic Pouchitis With JAK Inhibitors and S1P Receptor Modulators: An ECCO CONFER Multicentre Case Series.
{Author}: Ribaldone DG;Testa G;Verstockt B;Molnar T;Savarino E;Schmidt C;Vieujean S;Teich N;Meianu C;Juillerat P;Grellier N;Lobaton T;
{Journal}: J Crohns Colitis
{Volume}: 18
{Issue}: 5
{Year}: 2024 May 31
{Factor}: 10.02
{DOI}: 10.1093/ecco-jcc/jjad194
{Abstract}: <B>OBJECTIVE: </B>Data regarding the effectiveness and safety of Janus kinase [JAK] inhibitors and sphingosine-1-phosphate [S1P] receptor modulators in antibiotic refractory chronic pouchitis [CARP] are lacking.<BR><B>METHODS: </B>This ECCO-CONFER project retrospectively collected data for JAK inhibitor or S1P receptor modulator treatments for CARP with at least 3 months of follow-up. The outcomes included corticosteroid- and antibiotic-free clinical response and remission at 3 and 12 months, and trends in modified pouchitis disease activity index [mPDAI], endoscopic PDAI, C-reactive protein, and calprotectin.<BR><B>RESULTS: </B>Seventeen treatments in 15 patients were evaluated. Previous pouchitis treatments included infliximab [5/15], adalimumab [4/15], vedolizumab [9/15], and ustekinumab [5/15]. Pooling data on JAK inhibitors [eight tofacitinib, one filgotinib, and six upadacitinib] after 3 months [T3], steroid- and antibiotic-free clinical response was achieved in 53.3% [8/15], and steroid- and antibiotic-free clinical remission was achieved in 40% [6/15]. Of the patients with at least 12 months of follow-up, steroid- and antibiotic-free clinical response was achieved in 50% [3/6] and remission in one patient [16.7%], endoscopic response in 50% [3/6], and endoscopic remission in 50% [3/6]. Of the two ozanimod treatments at T3, steroid- and antibiotic-free clinical response was achieved in one patient, without remission; both discontinued ozanimod before T12. No side effects were reported.<BR><B>CONCLUSIONS: </B>Small molecules may represent a suitable option for CARP refractory to multiple biologics, deserving further investigation.