P2573 - Comparative Effectiveness of Bile Acid Sequestrants and Antibiotics in the Management of Pouchitis: A Matched Cohort Study From the United States

Award: Presidential Poster Award

Saqr Alsakarneh, MD¹, Michael Camilleri, MD, MACG², Abdulla Massad, MD³, Francis A. Farraye, MD, MSc⁴, Jana G. Hashash, MD, MSc^4
1University of Missouri - Kansas City School of Medicine, Kansas City, MO; ²Mayo Clinic, Rochester, MN; ³University of Texas Medical Branch, Galveston, TX; ⁴Mayo Clinic, Jacksonville, FL

Introduction: Bile acid sequestrants (BAS) are an emerging option for treatment of pouchitis. There is paucity of evidence regarding the effectiveness of BAS compared to standard treatment with antibiotics. We aimed to evaluate the comparative effectiveness of BAS monotherapy, antibiotic monotherapy, and combination therapy (BAS and antibiotics) in the treatment of pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC).

Methods: We conducted a retrospective cohort study using the US-Collaborative TriNetX database to identify patients ≥18 years with acute pouchitis and UC. Treatment groups were divided into: BAS (cholestyramine, colesevelam, colestipol), antibiotics (ciprofloxacin and/or metronidazole), and combination therapy of both BAS and antibiotics. Primary outcomes were failure of initial therapy (early relapse or nonresponse) and the development of recurrent pouchitis in the first 12 months after an initial episode of pouchitis. Using 1:1 propensity score matching, we adjusted for age, sex, race, smoking, obesity, primary sclerosing cholangitis and previous exposure to tumor necrosis factor inhibitors between the cohorts.

Results: Our analysis included 1064 patients (mean age 35.8±15 years, female 44%) of who 677 (64%) developed recurrent pouchitis. After adjusting for confounders, there was no significant difference in the odds of early relapse or nonresponse with BAS compared with antibiotic monotherapy (aOR: 0.81; 95% CI: 0.42-1.54) or combination therapy (aOR: 0.77; 95% CI: 0.38-1.57) (Table 1). When compared with patients treated with antibiotics, patients treated with BAS had a statistically significant lower recurrent pouchitis rate (aOR: 0.39; 95% CI: 0.23-0.68). Using Logrank test model to compare the time to development of recurrent pouchitis, patients treated with BAS (225 days) had a statistically significant longer time to recurrent pouchitis (p< 0.001) when compared to antibiotics (99 days) (Figure 1).

Discussion: Using real-world evidence, our cohort study showed that, for treatment of pouchitis, BAS monotherapy was not significantly different from antibiotic monotherapy or combination therapy in terms of early relapse or nonresponse. However, BAS was associated with a significantly lower rate and a longer time to recurrent pouchitis compared to antibiotics. These findings suggest that BAS may offer a promising alternative for the management of pouchitis, warranting further prospective studies to confirm their efficacy and long-term outcomes.



Disclosures:


Saqr Alsakarneh, MD¹, Michael Camilleri, MD, MACG², Abdulla Massad, MD³, Francis A. Farraye, MD, MSc⁴, Jana G. Hashash, MD, MSc⁴. P2573 - Comparative Effectiveness of Bile Acid Sequestrants and Antibiotics in the Management of Pouchitis: A Matched Cohort Study From the United States, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.