Effectiveness of vedolizumab treatment in two different anti-tumor necrosis factor alpha refractory pouchitis: A case report

Table 1 Effect of vedolizumab treatment of pouchitis in the literature

Country and reference	Number of patients	Age and gender	Features of inflammatory bowel disease	Outcomes
United States and reference 8	1	41-year-old female	She had pouchitis; 2 years later IPAA	Improvement in clinical symptoms and decreased frequency of bowel movements to four to six per day without blood or mucus were reported with 6 wk of vedolizumab treatment. There were no side effects
Italy and reference 9	1	33-year-old male	Anti-TNF-refractory chronic pouchitis and concomitant PSC	3 mo after ileostomy closure, chronic pouchitis occurred, refractory to antibiotics and anti-TNF. Thus, vedolizumab was started, leading to a marked improvement in clinical symptoms, which was maintained to the end of follow up (wk 34). There were no side effects
Germany and reference 10	20	12 male, 8 female; The median age was 22.5 years old	All of the patients were diagnosed with pouchitis	Improvement of clinical symptoms, the Oresland score and the PDAI score. There were no side effects
Greece and reference 11	1	22-year-old female	She was first diagnosed with pouchitis 1 year after surgery. Administered infliximab followed by adalimumab, both of which she discontinued after an early severe allergic reaction	Vedolizumab was subsequently initiated, together with a single course of antibiotics, and the patient experienced improvement in clinical symptoms and laboratory results with no documented relapse since then. A new pouchoscopy at wk 33 showed significant improvement
Greece and reference 11	1	22-year-old female	She was first diagnosed with pouchitis 1 year after surgery. Administered infliximab followed by adalimumab, both of which she discontinued after an early severe allergic reaction	Vedolizumab was subsequently initiated, together with a single course of antibiotics, and the patient experienced improvement in clinical symptoms and laboratory results with no documented relapse since then. A new pouchoscopy at wk 33 showed significant improvement
United States and reference 12	12	9 female, 3 male; The mean age was 41 years old	All of the patients had active pouchitis. Five patients (41.7%) used mesalamine, six (50.0%) took budesonide and four (33.3%) took prednisone prior to using vedolizumab. Eight (66.7%) had used anti-TNF agents prior to vedolizumab use	Eight (66.7%) patients demonstrated significant reduction in mPDAI symptom subscores before and after vedolizumab therapy
Portugal and reference 13	1	20-year-old female	She was diagnosed with pouchitis and a severe symptomatic autoimmune hemolytic anemia 1 year after IPAA	Patient reported symptom improvement at wk 12 and a pouchoscopy revealed only mucosal edema after 6 mo of therapy. Her inflammatory markers and hemoglobin normalized on repeat testing, allowing steroid withdrawal

IPAA: Ileal pouch-anal anastomosis; TNF: Tumor necrosis factor; PSC: Primary sclerosing cholangitis; PDAI: Pouchitis disease activity index; mPDAI: Modified pouchitis disease activity index.