Anti-TNF vs vedolizumab in refractory pouchitis

What is known

• Anti-TNF (infliximab/adalimumab) induces remission in ~50–53% of chronic antibiotic-refractory pouchitis (CARP) patients, while pooled vedolizumab data show ~75% week-12 clinical response. ^1,2
• Where compared, the data point if anything toward vedolizumab being at least equivalent and better tolerated long-term. ^1,3

What is unknown / caveats

• There is no robust head-to-head evidence establishing anti-TNF superiority over vedolizumab in CARP
• The data are observational
• The ~50–53% and ~75% figures come from separate uncontrolled series with different endpoints, not a direct comparison.

References

1. Tome J, Raffals LE, Pardi DS. Management of Acute and Chronic Pouchitis. Dis Colon Rectum. 2022;65:S69-S76. PMID: 35905290.

2. Ribaldone Davide G, Pellicano R, Saracco Giorgio M, Morino M, Astegiano M. Vedolizumab for treatment of chronic refractory pouchitis: a systematic review with pool analysis. Rev Esp Enferm Dig. 2020;112:59-63. PMID: 31823641.

3. Verstockt B, Claeys C, De Hertogh G, Van Assche G, Wolthuis A, D'Hoore A, Vermeire S, Ferrante M. Outcome of biological therapies in chronic antibiotic-refractory pouchitis: A retrospective single-centre experience. United European Gastroenterol J. 2019;7:1215-1225. PMID: 31700634.

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