Abstract Background Ileal pouch–anal anastomosis (IPAA) is the preferred surgery for ulcerative colitis (UC) refractory to medical therapy or complicated by cancer. Pouchitis and Crohn’s-like disease of the pouch are the most common complications. Although advanced therapies are increasingly used for chronic pouchitis, data on how prior exposure affects subsequent treatment response remain limited. Methods This single-center retrospective study included 24 adults with UC who underwent IPAA and developed chronic pouchitis. Diagnosis was based on a modified Pouchitis Disease Activity Index (mPDAI) ≥7 with an endoscopic subscore ≥2. All patients received biologic and/or small-molecule therapy. Response at 6 months was defined as mPDAI ≤4. Patient and disease characteristics, pre-surgical treatments, surgical parameters and therapeutic data were collected. Comparative analyses were performed using Fisher’s exact test. Results Among 24 patients (14 males, 10 females; mean age 47.9 years) 18 (75%) had pouchitis and 6 (25%) had Crohn’s like disease of the pouch. The mean disease duration from surgery to pouchitis was 4.5 (IQR: 1-5.25) years and the mean UC disease duration was 7.8 (IQR: 5-9.5) years. The biologic and small-molecule agents used for chronic pouchitis treatment included vedolizumab, infliximab, ustekinumab, adalimumab, mirikizumab, golimumab, upadacitinib, and risankizumab. These therapies were administered across treatment lines ranging from first- to fifth-line, as illustrated in Figure 1. Infliximab was reintroduced in five patients; two of them (40%) experienced allergic infusion reactions that led to treatment discontinuation. Response rates per therapy were: vedolizumab: 55% (11/20), infliximab 29% (2/7), ustekinumab 62.5% (5/8), adalimumab: 0/2, risankizumab: 0/2, mirikizumab: 1/2, golimumab: 0/1, upadacitinib: 0/1. All patients who received ustekinumab were naïve to this agent. Prior exposure to vedolizumab was not associated with a statistically significant difference in treatment response at 6 months (OR = 6.07, p = 0.157). Furthermore, prior exposure was not also associated with treatment response at 6 months among patients receiving a biologic agent or small molecule as first-line or second-line therapy (p = 0.65, p = 1.0, respectively). No other factors significantly affected the response to first-line biologic therapy at 6 months (Table 1). Conclusion Prior exposure to advance therapy before colectomy did not significantly affect response to subsequent advanced therapy initiation in chronic pouchitis. Patients previously exposed to infliximab showed increased rates of adverse events related to immunogenicity upon reintroduction. Conflict of interest: Dr. Fousekis, Fotios: No conflict of interest Jefremow, André: No conflict of interest Katsanos, Konstantinos: AbbVie, Amgen, Athos, Αenorasis, Biocon,Biogaia, Drugssales Ltd, Epsilon Health, Falk, Faran, Ferring, Genesis, Grifols S.A., Hospital line, Johnson&Johnson, COPER, MSD, Biocon, Pfizer, Potamitis Medicare, Rafarm, Petsiavas, Shire,Takeda, Vianex, Lilly Neurath, Markus Friedrich: Personal Fees: Janssen-Cilag GmbhConsulting BMA houseConsulting Pentax GmbHConsulting S. KargerConsulting Galapagos NVConsulting Boehringer Ingelheim International GmbHConsulting Aclaris TherapeuticsConsulting TRex Bio, Inc.Consulting SciRhom GmbHConsulting Pfizer Biopharmaceuticals GroupConsulting Aditum Bio Management Company, LLCConsulting Carpamel Ransford LLPConsulting Pfizer Pharma GmbHConsulting Janssen-Cilag GmbHSpeaker activities Falk Foundation e.v.Speaker activities Affiliate Faculty, Skaggs School of Pharmacy & Pharmaceutical Sciences Speaker activity Medi K S.r.lSpeaker activity AOCCSpeaker activity Lilly Deutschland GmbH Speaker activity Northwell FoundationSpeaker activity Takeda pharma GmbHSpeaker activity, Consulting AbbVie NV/SASpeaker activity, Consulting Fondazione Internazionale MenariniSpeaker activity ARIX Bioscience Holding Limited Speaker activity Takeda Pharma Vertrieb gmbH & Co. KGSpeaker activity, Consulting Atreya, Raja: RA has served as a speaker, or consultant, or received research grants from AbbVie, Abivax, AlfaSigma, Arena Pharmaceuticals, Astra-Zeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion Healthcare, Dr Falk Pharma, Galapagos, Gilead, GlaxoSmithKline, InDex Pharmaceuticals, Johnson & Johnson, Lilly, Materia Prima, Merck Sharpe & Dohme, Pfizer, Roche Pharma, Takeda Pharma, Viatris.
Fousekis et al. (2026) studied this question.